Purchase and Referred Care Manager

COQUILLE INDIAN TRIBE•Coos Bay, OR

9d•$74,942 - $89,918•Onsite

About The Position

The Purchase and Referred Care (PRC) Manager coordinates and facilitates administration of Purchased & Referred Care for the Coquille Indian Tribe’s Health & Wellness Division. The role works under the direct supervision of the PRC and Registration Manager and supports culturally responsive healthcare, rehabilitation, wellness, and prevention services through the Ko-Kwel Wellness Center and Shishda Haws Rehabilitation & Fitness Center. The position provides leadership and oversight to the PRC Registration Specialist, administers PRC operations and funding, maintains program systems and records, and coordinates with patients, healthcare providers, vendors, government agencies, and internal teams. It also manages related programs and processes, including catastrophic health emergency funding cases, the Retiree Subsidy Drug Program, Tribal Premium Sponsorship, Medicare premium reimbursements, and Medicare Like Rates repricing. Work is generally performed in an office setting and outdoors. The role may involve transporting patients and clients in Tribal, personal, or rental vehicles. Local travel is frequent, while statewide and national travel is occasional. Occasional evening and weekend work is required. The position requires the ability to perform its duties safely and effectively, with or without reasonable accommodation.

Requirements

Associate’s degree in Public Health, Healthcare Administration, Business, or a related field, or an equivalent combination of education and experience.
Three years of management and supervisory experience in a public health or medical outpatient setting.
Knowledge of and experience working with Medicaid, Medicare, and private health insurance.
Knowledge of HIPAA privacy and confidentiality guidelines.
Current and valid driver’s license in good standing, with no insurability restrictions from the Tribe’s insurance carrier.
Accept responsibility as a mandatory reporter of abuse and neglect involving infants and children, elderly or dependent people, individuals with mental illness or developmental disabilities, and residents of nursing homes and other healthcare facilities.
First Aid/CPR certification, or ability to obtain it within 90 days of employment.
Excellent verbal and written communication skills, including team building and cooperative problem solving.
Ability to maintain a pleasant and helpful attitude and use strong interpersonal and communication skills in stressful or emotional situations.
Ability to foster an inclusive workplace that values diversity and individual differences.
Ability to develop others through ongoing feedback and formal and informal learning opportunities.
Results-driven decision-making skills, including applying technical knowledge, analyzing problems, and calculating risks.
Knowledge and skill in department-level administration, including personnel and budget management, procurement, contract, grant and agreement preparation and administration, and program evaluation and reporting.
Ability to maintain effective working relationships with outside government officials, administrative agencies, and granting agencies.
Ability to carry out all phases of grant administration, including writing grant applications, developing and tracking budgets, and grant reporting.
Ability to read and understand technical documents and manuals and write such documents for others.
Computer literacy sufficient to use word processing, spreadsheet, and database software to produce correspondence, documents, and reports.
Ability to maintain professionalism, confidentiality, and objectivity under pressure and in crisis situations.

Nice To Haves

Knowledge of Indian Health Service and Purchase and Referred Care.
Knowledge and experience with Quality Improvement and Accreditation.
Experience in health insurance or managed care, especially claims processing.
Experience working within a Tribal environment.

Responsibilities

Provide leadership and oversight to the PRC Registration Specialist, including hiring, orientation, training, work assignment, performance evaluation, coaching, feedback, and assistance with disciplinary measures.
Assist with developing and implementing budgetary processes.
Administer the PRC program and maintain PRC data systems and their use in program operations.
Issue denial letters for noncompliance with the PRC program and pursue the use of alternate resources.
Audit claims for payment and pre-authorize, pre-obligate, and approve PRC funds for healthcare providers.
Maintain PRC social media, mailings, and reports.
Draft PRC policy and procedure modifications for presentation to advisory and governing bodies.
Serve as an Oregon Health Authority Medicaid Community Partner.
Engage with PRC enrollees to offer support.
Manage electronic payment and processing systems.
Manage, maintain, and file appropriate Catastrophic Health Emergency Funding cases with Indian Health Services.
Manage the Retiree Subsidy Drug Program to maximize rebates and revenue.
Administer the Tribal Premium Sponsorship Program and provide Medicare premium reimbursements to eligible Tribal members.
Negotiate discounts with vendors and providers and collaborate with vendors to provide patient care and case management.
Develop and maintain a thorough understanding of PRC policies and procedures.
Coordinate with health information technology personnel to improve and maintain accurate system work processes, claims submissions, and logistics.
Coordinate and conduct Resource Management Committee meetings.
Manage the Medicare Like Rates repricing program and provide required reports.
Perform other duties as assigned.
Transport Native American and non-Native patients and clients in Tribal, employee-owned, and rental vehicles when required.