Purchased Referred Care Client Navigator - TEMP Closes 10/6/26

SUMMARY:

Position shall be responsible for personalized guidance to patients as they move through the healthcare system, facilitating timely care and eliminating barriers to services on referrals processed by Purchased Referred Care (PRC). The Client Navigator will also address financial, social, and/or logistical challenges in according to United Indian Health Services (UIHS) PRC guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Level I

• Maintains PRC files accurately, including documentation on the time and date of telephone calls to clients and providers, the status of the referral, and all follow-up required to complete the referral process from beginning to end.
• Have the ability to use or be trained in the use of the various computer software systems used by the organization to perform all job duties.
• Assists clients with referrals pending PRC assistance, in completing the documentation required to move the referral to approved status, or to be covered by an alternate resource.
• Ability to communicate effectively with the PRC Referral Technicians that process the referrals when clarification or guidance is needed.
• Assists clients with scheduling appointments, managing paperwork, and coordinating care across different healthcare settings and providers.
• Assists in connecting clients with appropriate community resources, including financial assistance programs, social support services, and mental health services.
• Identifies and addresses barriers to care, such as transportation, insurance, and location of services.
• Responsible for outreach efforts to establish and maintain positive working relationships with physicians, office staff, diagnostic staff, and social services staff, etc.
• Demonstrates sensitivity and responsiveness to a diverse client population, including but not limited to diversity in culture, race, gender, religion, abilities and sexual orientation.
• After the initial consultation, assists clients with follow-up care, including requesting PRC Secondary Authorization forms from third party providers, as well as following the client through the continuum of care.
• Communicates and corresponds with UIHS providers to clarify PRC referrals.
• Tracks PRC cases through the processes of appointment, outcome, third party insurance eligibility determination, and final claims payment processing.
• Reviews open purchase order reports to find any that are over six months old without activity to cancel or follow-up on why it is still open. This will help us maintain an obligation balance more accurately.
• Prepares periodic reports on claims reviewed, follow-up of the pending, and processed to completion. Completion is concluded with established continuum of care for the client.
• Runs monthly reports, exports, and other miscellaneous reports as needed.
• Attends and participates in PRC-related meetings at both Board and Administrative levels as needed.
• Ability to work independently and as part of a team.
• Willing to learn more about the American Indian culture and attend at least one Cultural Presentation/Training per year.
• Willing to work with American Indian/Alaska Native people and demonstrate cultural awareness and humility
• Willing to deliver services in a culturally responsive manner.
• Adheres to accreditation and compliance standards/guideline
• Other duties may be assigned.

Level II – All of the above duties and the duties below:

• Assists with Catastrophic Health Emergency Fund (CHEF) cases by helping clients obtaining documents required for submission.
• Suggests updates or changes to the originating Referral Technician in order to improve services for our clients.
• Trains a Level I and II PRC Client Navigators.
• Able to build and interpret reports and data to the PRC Manager.

Levell III – All of the above duties and the duties below:

• Researches client profiles, updates needed information and collaborate changes to originating PRC Technician.
• Assists with updating standard operating procedures and policies to better serve our clients.
• Able to lead a team of PRC Navigators.
• Able to provide presentations for UIHS staff and community, explaining what PRC Navigators do and how they benefit our clients and staff.
• Assists PRC Manager with presentations to the Board and or Staff.

SUPERVISORY RESPONSIBILITIES: This position has no supervisory responsibilities.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. All individuals must demonstrate a commitment to the provision of culturally sensitive counseling services to American Indians.

EDUCATION/EXPERIENCE: Educational degrees must be from a US Department of Education accredited school

Level I

• Must have High school diploma or general education diploma (GED); and
• Two (2) - three (3) years of experience working in customer service, front office, sales and/or client-facing service in health care settings. Knowledge of PRC is preferred but not required.
• Must demonstrate a good understanding of PRC within 90 days of hire.

Level II

• Must have AA degree in a related field and two (2) years of experience working in PRC or equivalent combination of education and experience.
• Proficient in PRC and electronic health record systems.
• Eight (8) hours of Navigator Training

Level III

• Must have BA/BS degree in a related field and one (1) year of experience or five (5) years of experience working in PRC or equivalent combination of education and experience.
• Navigator Certification