Hybrid Purchased Referred Care Supervisor bei Northeastern Tribal Health System

Description

Position Summary: Provides support to the Purchased and Referred Care (PRC) department, which contributes to the direct health care assistance of eligible American Indian/Alaska Native beneficiaries.

Position responsibilities:

• Receives consults from providers, prepares referrals in RCIS, counsels patients on PRC policies and the Privacy act, processes the referral document, and makes appointments with the appropriate provider to facilitate patient access to specialty care in the private sector.
• Paperwork must be processed accurately and timely, patients must be counseled effectively, and appointments must be made with the appropriate specialist and within the right time frame.
• Performance is reflected by the number of mistakes or omissions in the processing of paperwork, appointment scheduling, or in choosing the right specialist, and by the degree of timeliness with which these tasks are performed.
• Committee to facilitate patient access to assistance with emergent care received in the private sector. Call-in information must be recorded accurately.
• Maintains daily phone and patient contact logs recording pertinent patient information.
• Obligates funds on approved cases and maintains an up-to-date estimate of available funds, processes purchase orders for completed services and submits the DCR on time to facilitate an ongoing estimate of funding available.
• Prepares weekly review committee minutes with supporting medical documentation.
• Issues denial/deferred letter for referrals/call-ins not approved for payment. Processes appeals and submits information to the Chief Executive Officer or Administrative Officer for reconsideration.
• Supervises the functions and staff of Purchased & Referred Care.
• Other duties as assigned.

Requirements

Essential skills and experience:

• Minimum of 5 years of experience preferred/Supervisory experience preferred.
• Knowledge of basic and established procedures related to the routine and repetitive aspects of PRC support work.
• Must have knowledge of simple mathematical calculations. Must have knowledge of personal computers and be able to type with minimum errors.
• Leadership: demonstrated ability to lead people and get results through others.
• Management: ability to organize and manage multiple priorities.
• Excellent interpersonal and communication skills.
• Problem analysis and problem resolution at both a strategic and functional level.

Valued but not required skills and experience:

• Bachelor’s Degree in Health Administration, Business Administration or related field.

Reporting to this position: Purchased & Referred Care Clerks

Physical demands and work environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical Demands: While performing duties of job, employee is occasionally required to stand; walk; sit; reach with hands and arms; talk and hear. Employee must occasionally lift and/ or move up to 25 pounds.
• Work Environment: The noise level in the work environment is usually moderate.

Indian preference applies. Applicants can submit an application, resume with a cover letter, and a copy of CDIB or Tribal membership card (if applicable) to Northeastern Tribal Health System, Human Resources Director, Audrey Fenoughty , P.O. Box 1498 Miami, OK 74355, faxed to (855)745-3601, or emailed to [email protected] . Selection of the qualified applicant is contingent upon drug screen and background check. Applications will be accepted until position is filled.

• Monday-Friday
• Minimal overtime
• FREE Health and Life insurance to NTHS employees.
• 10 hours of personal leave (Annual and Sick) is accrued bi-weekly.
• 6% total match on 401K

Advertising until filled.