PRC Specialist/Referral Coordinator

OPENING DATE:  February 26, 2026

CLOSING DATE:  Open Until Filled

*Shift: Monday-Thursday 8:00AM-5:00PM, Friday 8:00AM-1:00PM

POSITION SUMMARY: Coordinates and manages Purchased/Referred Care (PRC) and specialty referral processes for patients served by Red Berry Health System. Ensures referrals are appropriate, authorized, documented, and tracked in compliance with applicable federal, tribal, and program requirements while supporting timely access to medically necessary care.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Coordinates PRC and specialty referrals in accordance with applicable policies, procedures, and eligibility requirements.
• Reviews provider referrals for completeness, medical necessity, and required documentation prior to submission.
• Prepares and submits referral requests, authorizations, and supporting documentation to PRC programs, specialists, and external facilities as required.
• Tracks referral status from initiation through completion, ensuring follow-up and continuity of care.
• Communicates referral requirements, authorizations, and appointment information to patients, families, providers, and external referral partners.
• Maintains accurate and timely documentation of referrals, authorizations, denials, and outcomes in the electronic medical record and tracking systems.
• Coordinates closely with providers, nursing staff, and care teams to support appropriate referral utilization and patient care planning.
• Monitors referral timeliness and identifies barriers to access, escalating issues as appropriate.
• Maintains compliance with HIPAA, patient confidentiality requirements, and Comanche Nation policies.
• Assists with reporting, audits, and data requests related to PRC utilization and referrals as needed.
• Performs other position-related duties as assigned.
• This position has no supervisory responsibilities.

REPORTS TO:  Will Report to Clinic Director, CEO or Designee (Red Berry Health System), with day-to-day operational coordination through Vestra Tribal Care Management.

PHYSICAL DEMANDS:        

The physical demands 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.

While performing the duties of this Job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; sit and use hands to finger, handle, or feel. The employee is occasionally required to reach with hands and arms; stoop, kneel, crouch, or crawl and taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee may be exposed to fumes or airborne particles, virus, disease and infection.  The employee may experience traumatic situations. The employee may occasionally be exposed to toxic or caustic chemicals and risk of electrical shock. The noise level in the work environment is usually quiet.

• Work Schedule: Monday - Thursday, 8 am - 5pm. Friday 8 am – 1:00.
• Travel Required: Occasionally

QUALIFICATIONS:

Minimum Qualifications:

Education:

• High school diploma or equivalent required.
• Associate degree or certificate in healthcare administration, medical assisting, or related field preferred.

Experience:

• At least two (2) years of experience in referral coordination, PRC, case management, medical office administration, or related healthcare role preferred.
• Experience working with tribal health programs, PRC processes, or third-party payers preferred.

Knowledge and Skills:

• Knowledge of referral coordination, authorization processes, and medical documentation requirements.
• Familiarity with PRC or specialty referral workflows preferred.
• Strong organizational, time-management, and attention-to-detail skills.
• Strong interpersonal and communication skills.
• Ability to work collaboratively with providers, staff, patients, and external partners.
• Proficiency with Electronic Medical Records and basic computer applications (word processing, spreadsheets, internet).

ADDITIONAL REQUIREMENTS:

• Must comply with Comanche Nation policies and procedures
• Must maintain confidentiality of sensitive information
• Requirements as set forth in the specific contract for the site may include working flexible hours including evenings, nights and weekends.  Travel for training may occasionally be required.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.

EQUAL OPPORTUNITY EMPLOYER: The Comanche Nation does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

COMANCHE PREFERENCE applies in accordance to the Comanche Nation Human Resources Policies and Procedures. Eligible applicants must submit proof of enrollment with employment application to receive Comanche preference.  

INDIAN PREFERENCE applies in accordance with Indian Preference Act of 1934 (Title 25, USC Section 472), Form 4432 must be submitted with employment application to receive Indian Preference. Non-Indian applications will be considered in the absence of qualified Comanche and/or Indian preference applicants. 

VETERAN PREFERENCE applies in accordance to the Comanche Nation Human Resources Policies and Procedures. Eligible applicants must submit proof of veteran status, DD Form 214, with employment application to receive veteran preference

Salary : $20 - $26