Employment Opportunities
Director of AST Purchased Referred Care (PRC)
This position is currently open.
Public?:
Public
Division:
Health
Reports To:
Medical Director
Type of Position:
Regular Full Time
Location:
Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
General Description
The Director of Purchased/Referred Care (PRC) provides strategic leadership and oversight of the PRC Program for the AST Health System, a tribally operated healthcare organization. The PRC Program ensures access to medically necessary services not available within AST or IHS facilities by coordinating and funding care through private sector providers in accordance with Indian Health Service (IHS) regulations and applicable program guidelines. This position ensures regulatory compliance, fiscal stewardship, and effective management of limited PRC resources while adhering to eligibility requirements, medical priority levels, and alternate resource utilization standards. The Director oversees centralized referral operations for medical, dental, and specialty services; ensures timely and accurate processing of purchase orders and payments; and supports coordinated patient care throughout the referral process. The Director provides dual-site supervision of PRC offices at the Little Axe and Shawnee Clinics and collaborates closely with executive leadership, medical staff, and business operations to ensure efficient, compliant, and patient-centered service delivery. All financial transactions remain subject to review and approval by the Executive Director or designee. This role includes providing supervisory support in the absence of the other director to ensure continuity of operations.
Responsibilities & Duties
Provide full oversight and operational leadership of the PRC Program in collaboration with the Executive Director and key health system leadership.
Oversee daily review of referral and medical records processes to ensure completeness and compliance.
Ensure program compliance with Indian Health Service (IHS) PRC regulations, CHEF requirements, and AST Health System policies and procedures.
Lead the Case Conference Medical Review (CCMR) process, coordinating with the Medical Director and leadership to evaluate medical necessity and payment determinations in accordance with established priorities and guidelines.
Participate in Quality Improvement (QI), compliance, and program evaluation initiatives to strengthen operational effectiveness and regulatory adherence.
Represent the PRC Program at quarterly IHS Area Office meetings, CHEF Interlink initiatives, and relevant committee meetings.
Oversee and ensure proper coordination of all internal and external specialty referrals, including medical and dental services.
Ensure completion of required pre-authorizations, eligibility determinations, documentation submission, and follow-up for referred services.
Monitor referral workflows to confirm timely appointments, receipt of medical records, and appropriate patient follow-up through completion of care.
Collaborate with the Business Office, Medical Review Team, providers, and Patient Benefits Advisor to determine eligibility, alternate resource utilization, and payment authorization.
Support development and maintenance of a paperless referral network within the Electronic Health Record (EHR) system.
Oversee accurate issuance of purchase orders (POs) for referred services and ensure appropriate coordination of payment processes.
Ensure prompt and accurate preparation and submission of Catastrophic Health Emergency Fund (CHEF) cases.
Maintain accurate databases and electronic record systems for PRC accounting, expenditures, patient eligibility, and reporting.
Prepare and submit required statistical, financial, and grant compliance reports.
Maximize utilization of alternate resources, including private insurance and ACA sponsorship programs.
Ensure patients are screened for and enrolled in applicable insurance programs and alternate resource options.
Provide leadership and oversight of ACA Sponsorship activities in coordination with administration and key staff.
Monitor private insurance referral processes and ensure compliance with payer requirements.
Serve as liaison between PRC, Contract Health entities, IHS, providers, and external healthcare partners to ensure continuity of care.
Communicate with attending physicians and outside providers as necessary to support medical necessity documentation and coordination of care.
Promote appropriate utilization of services, including education and outreach initiatives such as the PlusCare after-hours program to reduce unnecessary emergency room utilization.
Participate in public relations activities, tribal events, health fairs, and community engagement efforts to promote awareness of PRC services.
Conduct regular program meetings and participate in multidisciplinary case management committees.
Travel for training, conferences, and required external meetings.
Maintain professional representation of the PRC Program through positive leadership, collaboration, and conduct.
Perform other related duties as assigned.
Education Requirements and Qualifications
Education and Qualifications
Bachelor’s Degree in health-related or business field or certification in medical or similar healthcare position preferred.
Licensed Registered Nurse or Licensed Practical Nurse preferred.
Minimum of three years of previous successful experience in managing authorizations/referral type programs in a tribal health or similar clinic/hospital preferred.
Demonstrated experience leading multi-site teams and supervising professional and administrative staff, including performance management, coaching, and workforce development.
Experience managing or overseeing budgets, financial processes, and fiscal accountability, including responsible stewardship of limited funding resources.
Experience working for Native American Tribal Health System, Government or Business, preferred.
Basic medical knowledge for handling the PRC cases including medical billing and terminology.
Knowledge, Skills and Abilities
Knowledge of Tribal communities, specifically the Absentee Tribal community preferred.
Knowledge of the Health Insurance Portability & Accountability Act (HIPAA) laws and the support of its laws and OSHA.
Knowledge of Indian Health Services (I.H.S.), specifically the PRC program and its’ guidelines.
Knowledge of Resource and Patient Management System (RPMS) and other relevant clinical and administrative resource tracking programs.
Effective oral and written communication at all levels demonstrating mastery of the English language.
Ability to communicate and work effectively with people from diverse socioeconomic backgrounds and education levels.
Ability to connect with others and forge strong relationships
Highly organized, technically competent – proficient in Microsoft Office programs; skilled in the development of health educational materials to support grant and other health related programs for marketing to various populations in need.
Ability to manage multiple tasks simultaneously, with strong time management skills.
Ability to maintain confidential information.
Working knowledge of AST culture and ability to speak the Shawnee language is a plus.
Must have a valid Oklahoma Driver’s License.
Must be able to pass a background check and drug test.
Physical Requirements and Working Conditions
Must be able to sit, stand, stoop, bend or kneel for long periods of time.
Prolonged sitting, standing, or walking; occasional bending, squatting, kneeling, and stooping; good finger dexterity and sensory perception; frequent repetitive motions; as well as talking, hearing, and visual acuity are required.
Frequent lifting (up to 15 lbs)
Occasional lifting (up to 30 lbs)
The Absentee Shawnee Tribe of Oklahoma (AST) is committed to Equal Employment without regard to race, religion, color, gender, national origin, age, disability, or sexual orientation. However, in accordance with the Indian Preference Act (Title 25 U.S. Code 472 and 473) preference in filling vacancies are given to qualified Indian candidates. AST will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and its amendments.
Native American Preference/EEO/Drug Free/Smoke Free Workplace
Posted Date:
3 days 12 hours ago