DEPARTMENT: Purchased Referred Care
SUPERVISED BY: Deputy Chief Executive Officer
SALARY: D.O.E.
EMPLOYMENT
CATEGORY: Regular, Full-Time,Exempt
OPEN DATE: 10/22/2025
CLOSE DATE: Until Filled
JOB SUMMARY:
The Purchased Referred Care (PRC) Director will oversee the PRC department to provide support and technical assistance to Administration on matters involving PRC including medical, surgical, dental, hospital, and clinical services to all eligible beneficiaries in conjunction with or in lieu of services performed at local Tribal healthcare facilities. The incumbent shares responsibilities for program planning, development, administration, management, operation, and evaluation of a comprehensive PRC program. The PRC Director will perform difficult and complex assignments which vary in scope and encompass a variety of program activities. This role requires strong customer service, leadership, coaching, organization, communication, complex analytical and problem solving skills.
DUTIES AND RESPONSIBILITIES:
Design, implement, and manage the PRC program that addresses the specific specialty healthcare needs of the Wind River Reservation.
Provides leadership and oversight to the PRC program and teams.
Ensures development of PRC initiatives to improve patient satisfaction and family centered care.
Collaboration with other internal departments and external specialty vendors for PRC program initiatives.
Leads and/or serves on a variety of appropriate internal and external committees to represent Wind River Family and Community Health Care (WRFCHC) PRC program.
Reviews, analyzes, and summarizes pertinent financial, statistical, and program data.
Develops yearly PRC spending plan to maximize the funds allocated to PRC for each Fiscal Year.
Maintains weekly fund status reports to provide current PRC funding level to Administration.
Prepares monthly reconciliation reports, identifies and corrects discrepancies on payments and adjustments.
Responsible for reporting of Catastrophic Health Emergency Fund (CHEF) cases, working closely with PRC staff, medical staff, IHS office staff, and Claims Management Program to report, manage, and monitor high cost cases funded through the CHEF program.
Monitors all unpaid open documents (pended) received from Claims Management Program, working closely with the vendors and providers to resolve.
Provides administrative and technical supervision to the PRC department staff by preparing schedules, assigning work based on needs of the department, advising, coaching, or issuing disciplinary action, and completing evaluations per WRFCHC Human Resource’s policy.
Develops, coordinates and integrates operational plans in accordance with approved policies and directives pertinent to the administration and management of the WRFCHC PRC program requirements (eligibility, payer of last resort, residency, etc.)
Prepare and present reports on program progress to executive management.
Research, develop, write, update, and implement PRC policies, standard operating procedures, competencies, and checklists in compliance with relevant laws, regulations, and organizational standards.
Participates in the weekly PRC referral review committee meetings.
Works with supervisor/CEO in establishing vendor contracts for Medicare Like Rate (MLR) agreements.
Reviews walk-through (emergent) referrals on an as needed basis. Approves or denies referrals based on administrative eligibility criteria.
Establishes and maintains mechanisms for assuring that patients register for benefits for which they may be eligible to ensure WRFCHC PRC program is a payer of last resort for referred services.
Manages appeals and denials at the local (WRFCHC) level with assistance from the PRC staff.
Assists with compiling training materials regarding the PRC process for internal and external stakeholders.
Trains vendors, interdisciplinary staff/departments on the PRC process, regulations, administrative processes, and other training needs.
Engages staff and other stakeholders in continuous improvement of systems and processes; manages resources for staff participation in improvement of PRC department work activities.
Responsible for timekeeping of designated PRC staff in accordance with WRFCHC Policies and Procedures.
Assist with hiring procedures and interviews of new staff for the PRC department.
Assists with presentations on PRC program requirements to patients, vendors, other agencies, and the general public as needed to ensure thorough understanding of the PRC program.
Other duties as assigned to maintain and enhance the operation of the department.
QUALIFICATIONS:
Knowledge of WRFCHC/Tribal organizational structure and operating policies. Understands the overall purpose of Tribal health care program effectiveness to meet the needs of IHS beneficiaries.
Knowledge of IHS and other federal regulations, policies and procedures that govern the administration of the PRC program.
Knowledge of the theories, principles, practices, and techniques of program planning, implementation, and evaluation.
Knowledge of supervisory methods and procedures.
Knowledge of current health care issues and emerging trends of the public and private health care industry.
Knowledge of the principles, practices, and techniques of health care financing, contracting and administration; including coordination of benefits, medical services and contracts and agreements.
Knowledge of available resources in local, regional, and national levels.
Minimum 3-5 years of experience in the health care field, with a preferred focus on tribal or underserved communities.
Preferred associates or bachelor’s degree in health care administration or related field.
Experience working in an integrated healthcare delivery system.
Must possess a valid driver license and be eligible for coverage under WRFCHC auto insurance policy.
Must be able to pass a criminal background check under the Indian Child Protection and Family Violence Prevention Act (P.L.101-630).
Current BLS Certification or be able to obtain it within 60 days of hire.
WORKING CONDITIONS:
Primarily office-based setting with frequent travel to other health care clinics and some educational community events.
Very busy atmosphere. Highly stressful when dealing with individual personalities of vendors, co-workers, patients, and their families.
Potential for exposure to illnesses found in a clinical setting.
Considerable standing, sitting, or walking.
Considerable reaching, stooping, bending, and crouching.
Lifts supplies and equipment up to 20 lbs occasionally and/or up to 10 lbs frequently.
EMPLOYEE BENEFITS:
Competitive wages (no state or local tax)
17 Federal Health Insurance Options
Dental and Vision Insurance
Life insurance
401k Retirement Plan with up to 4% match
Employer Paid Short Term Disability Insurance
Supplemental Insurance
Leave Benefits
Student Loan Repayment Options (certain eligibility requirements apply)
IMPORTANT APPLICATION CRITERIA:
Submit a complete application with supporting documents either online or to WRFCHC Human Resources Department located at 120 North 6th East (Old DFS Bldg.), Riverton WY 82501. Applicants must submit all supporting documents to be eligible for the position they are applying for.
Supporting documents: Driver’s License, Tribal ID, High School Diploma/GED, Degree or professional credentials, and other supporting documents that verify required qualifications.
Applicants not living in the local area may submit a cover letter, resume, and supporting documents in lieu of an application as an initial statement of interest for a particular job announcement. However, the applicant must follow-up with an official Wind River Family and Community Health Care job application.
Applicants who have a current application on file are required to submit a letter of interest for each position in which they want to be considered for. The letter should address how they meet each qualification. Supporting documents must be attached to the letter of interest.
Telephone calls are not accepted in place of an employment application or letter of interest.
When the position qualifications require a driver’s license, education, or professional credentials, the applicant must submit copies of certificates, licenses, degrees, and other supporting documentation. Applicants who do not provide supporting documents will be disqualified.
WRFCHC is an Equal Opportunity Employer. Preference will be given to a qualified tribal member, then a qualified tribal member of a federally recognized tribe and then other qualified candidates.
Qualified Indian Preference applicants must provide a copy of their tribal enrollment identification card or a Certificate of Indian Blood.
Background investigation, drug and alcohol screening are required as a condition of employment. Refusal will render the applicant ineligible for employment.
For information or questions, please contact Human Resources at 307-856-9281 ext. 367.