PLEASE NOTE - This position may require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center.

Position Summary:

The incumbent is responsible for coordinating referred health care for the Tohono O'odham Nation Health Care's patient population and providers.

Scope of Work: This position is located within the Tohono O'odham Nation's Division of Nursing Services, and Purchase Referred Care Division. It is situated organizationally and duty stationed at any Nation's facilities located in Sells, Arizona, Santa Rosa, Arizona, San Simon, Arizona, and Tucson, Arizona. The incumbent receives administrative direction from the Supervisory Nurse Specialist of the area to which assigned.

Essential Duties and Responsibilities: (Depending on the area of assignment, an incumbent may not be required to perform some of the duties listed below):

• Arrange initial and follow-up patient referrals regarding all patient care treatment phases through the referral process.
• Responsible for assisting in determining patient eligibility, scope, and priority for the PRC program.
• Respond to PRC inquiries and requests for PRC assistance made to the care team.
• Respond to internal inquiries and requests, including medical, social service, dental, etc., and external sources (private sector health resources).
• Responsible for implementing decisions made for the provision or denial of services.
• Responsible for ensuring necessary referrals are entered into the RCIS system.
• Assists patients in the scheduling of referred appointments.
• Provide education to patients on special instructions for referred visits.
• Follows up on referred visits scheduled to ensure the referring facility receives the visit records.
• Follows up with patients after referred visits to coordinate follow-up primary care visits as necessary.
• Maintains the Nation's commitment to registering for PRC funds for medical and dental services.
• Compiles reports of statistical data of referrals generated and closed every month.
• Responsible for keeping up-to-date pending and completed PRC patient files with a documented status of all written and verbal transactions.
• Works with Hospital professional and para-professional staff, local providers, tribal health committees; serves as a representative at meetings to create and maintain an understanding of the PRC programs and promote consumer and provider satisfaction.
• Incumbent must know computer applications relating to the PRC Program, including key entering and verifying all referrals and subsequent appointments for a panel of patients.
• Responsible for adding, deleting, changing, and verifying information in both the patient file and vendor.
• Contribute to a team effort.
• Other duties as assigned.

Knowledge, Skills, and Abilities:

• Knowledge of the Tohono O'odham culture, customs, and traditions.
• Knowledge of applicable federal, state, tribal laws, regulations, and requirements.
• Knowledge of legal regulations and confidentiality requirements, specifically the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Able to define PRC services, including eligible persons, how PRC supports direct care, federally recognized Indian Tribe, reservation, residency, descendancy, tribal affiliation, CHSDA, close social and economic ties, elderly, disabled, alternate resources, and medical priority levels.
• Able to obtain in-depth knowledge of all computer operations and sequence execution of Purchased/Referred Care programs and the online peripheral devices' relationship to the computer system.
• Knowledge of medical codes derived from the Indian Health Service Standard Code Book and the Contract Medical Care System Handbook.
• Able to learn Purchased/Referred Care guidelines and regulations necessary to assure that the prescribed procedures are appropriately applied.
• Broad knowledge of the various TONHC program functions related to the Purchased/Referred Care program.
• Ability and skill to coordinate the PRC office with others (i.e., vendors, physicians, support services, state agencies, etc.)
• Prepares good oral communication and writing skills to interact with referral program personnel, contract care facilities, and providers.
• Demonstrate skill in communicating with people from varied backgrounds and cultures, including communicating effectively with a wide variety of people, especially interaction with irate patients.
• Ability to work independently, use sound judgment, and meet deadlines.

Minimum Qualifications:

• High School Diploma or General Education Diploma.

Licenses, Certifications, Special Requirements:

• The completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), the Accrediting Bureau of Health Education Schools (ABHES), or any accrediting agency recognized by the United States Department of Education. Must provide a copy of official transcripts and diploma, OR;
• A current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Must provide a copy of the certification with the application, OR;
• The completion of a medical services training program of the Armed Forces of the United States. Must provide a copy of an official record that verifies the training received.
• Must obtain an Arizona Notary Public Commission certificate within six months of hire.
• Upon recommendation for hire, a criminal background and a National FBI fingerprint check are required to determine suitability for employment, including a 39-month driving record.
• May require possessing and maintaining a valid driver's license (no DUIs or major traffic citations within the last three years).
• If required, must meet the Tohono O'odham Nation tribal employer's insurance requirements to receive a driver's permit to operate program vehicles.
• Based on the department's needs, the incumbent(s) may be required to demonstrate fluency in both the Tohono O'odham language and English as a condition of employment.