What are the responsibilities and job description for the REFERRAL CARE SPECIALIST position at Fort Defiance Indian Hospital?
Closing Date: Monday, April 28, 2025 @ 4:00 P.M. (MST)
Salary Range: $23.52 - $28.69/hour
**APPLICANT MUST HAVE A VALID, UNRESTRICTED INSURABLE DRIVER’S LICENSE**
**RESUMES AND REFERENCES ARE REQUIRED**
ESSENTIAL DUTIES, FUNCTIONS AND RESPONSIBILITIES
• Evaluates and reports on PRC services provided by the Fort Defiance Indian Hospital Board, Inc. (FDIHB). Investigates and analyzes controversial issues and develops drafts related to reports, correspondence, and other written material.
• Assists in developing policies and procedures in the Purchased Referred Care Department.
• Performs liaison functions with Purchased Referred Care providers, state and local agencies; and monitors/reports status of Purchased Referred Care activities and funds.
• Prepares analytical data, staff reports and memoranda which reflect utilization of resources.
• Issues purchase orders obligating Purchased Referred Care funds and prepare the payment form and forward it to Finance for payment processing. .
• Assists and determines the PRC referrals based on the five (5) eligibility factors and if patients may qualify for alternate resources and/or catastrophic health emergency funds.
• Assumes responsibility for making outpatient appointment for referrals for patient being referred out of FDIHB for services not provided by the facility. Referral Care Center must work with providers who have a payment agreement established with the hospital.
• Works with outpatient providers, case managers, social workers, and hospital staff on patient referrals, making the best choice for patient to be seen externally for services not provided by FDIHB.
• Contacts the patient providing a patient referral, appointment notice, map of the location, and phone numbers.
• Provides PRC education to the patient and documenting all information into Referral Care Information System (RCIS).
• Evaluates pertinent purchased referred care cases and assembling, analyzing and checking statistical data.
• Advises patients and their families concerning eligibility and other facets of the Purchased Referred Care Program.
• Plans and develops orientation materials for patients, families, and hospital staff concerning Purchased Referred Care.
• Offers Purchased Referred Care assistance to eligible Indian people within fund limitations and operates within medical priorities.
• Conducts on-site patient interviews to establish eligibility for IHS patients for Purchased Referred Care Program.
• Provides assistance to individuals applying for services from other sources including Medicare, V.A., CMS and AFDC.
• Initiates Medical Purchase orders to include periods of hospitalization and medical fees for professional services.
• Assumes responsibility for the maintenance of complete Document Control Registers indicating Government appropriated funds for Contract patient care.
• Contacts PRC vendor and providers to provide them education on PRC/IHS policies and PRC procedures.
• Issues correspondence to patients, health care providers and other agencies regarding eligibility, IHS policy and regulations, including letters of denial of claims. Insures confidentiality of patient information.
• Prepares correspondence to third-party providers to obtain data on services provided.
• Other duties as assigned.
MANDATORY MINIMUM QUALIFICATIONS:
Experience:
Two (2) years of direct work experience
Education:
Associate’s degree in a related field or two additional years direct work experience
OR
Associate’s degree in a related field or equivalent experience
Please email degree or transcripts to elvera.shirley@fdihb.org
NAVAJO/INDIAN PREFERENCE:
FDIHB and its facilities are located within the Navajo Nation and, in accordance with Navajo Nation law, has implemented a Navajo/Indian Preference in Employment Policy. Pursuant to this Policy, applicants who meet the minimum qualifications for this position and who are enrolled members of the Navajo Nation will be given primary preference in hiring and employment for this position and members of other federally recognized Indian tribes will be given secondary preference. Other candidates will be considered only after all candidates entitled to primary or secondary preference have been fully considered.
Salary : $24 - $29
