Susanville Indian Rancheria: Purchased and Referred Care Specialist/ Health Benefits Coordinator
OPENING DATE OF ANNOUNCEMENT: May 21, 2026
CLOSING DATE OF ANNOUNCEMENT: June 1, 2026
POSITION TITLE: Purchased and Referred Care Specialist/ Health Benefits Coordinator
SUPERVISES: No
STARTING SALARY: $31.61 – $38.25 Depending upon experience and education.
GRADE: 12
FLSA STATUS: Non-Exempt
NUMBER OF POSITIONS: 1
STATUS: Permanent
HOURS: Full Time
BENEFITS: Highly competitive package *See below
SUBJECT TO P.L. 101-630: No
GENERAL STATEMENT OF RESPONSIBILITIES:
The Purchased and Referred Care Specialist/Health Benefits Coordinator (PRCS/HBC), under the supervision of the Purchased and Referred Care Manager, is responsible for developing and sustaining a Lassen Indian Health Center (LIHC) Specialty Care Network. The PRC program purchases health care and medical services that are not available at the LIHC. The PRCS/HBC administers and manages the contracting of health care services, with non-Indian Health Service (IHS) providers, for eligible Indian people residing within the Susanville Indian Rancheria (SIR) Contract Health Service Delivery Area (CHSDA) and will perform all necessary duties to ensure that Qualified Health Plans are assigned to beneficiaries and that they are the appropriate plan for each individual patient’s needs.
SPECIFIC AREAS OF RESPONSIBILITIES:
- Works closely with the medical, dental, and transportation departments (adhering to HIPAA and Privacy Act) to process patient referrals and assist in arranging transportation assistance for eligible patients.
- Provide PRC financial support for all referrals of patients eligible under the LIHC and Indian Health Service (IHS) policies and procedures, maintains an up-to-date and accurate record of expenditures and obligations, and negotiates to obtain the best service pricing
available. Must understand and utilize the MLR (Medicare Like Rate) to track obligations in
Excel and submit a monthly report to the PRC Manager. - Must use Resource and Patient Management System (RPMS) packages that pertain to the
PRC program and be knowledgeable of all applicable policies, current levels of care,
documentation of events, and filing requirements to ensure the PRC program functions
effectively and accurately. - Works with the Front Office Staff to ensure that patient eligibility information is current and
accurate. Assists patients in determining if they are eligible for tribal programs, alternate
health insurance, or other healthcare programs to assist with needs. Maintains a chart on
each patient receiving PRC. - Counsels and informs all patients that have not applied for alternate resources that they are not eligible for PRC funds to pay for their referrals. Ensures that patients are eligible for
PRC services before any cost is incurred. - Prepares a PRC denial to ineligible patients or specialty care providers within ten working
days of notice for payment. A copy of the denial will be placed in the appropriate patient’s
file. - Schedule patients referred to appointments in a timely and accurate manner. Follows-up on
all outstanding PRC referrals monthly to see if patients have been scheduled by specialty
care providers. Make sure referrals are moved from active to approved or closed status. - Answers telephone/written inquiries regarding eligibility requirements, payments,
outstanding charges, and other questions concerning the PRC Program. Maintains strict
confidentiality in responding to inquiries. - Assists patients with all health insurance plans and policies, coordinates the completion of
appropriate forms/applications and interprets rules and regulations for all alternate resources. - Other duties as assigned.
KNOWLEDGE SKILLS AND ABILITIES:
Basic office skills to include tele-communications, basic math, typing, telephone, filing, keyboard, copiers, computers, etc.
Ability to understand and interpret authorization of contract health care services as they relate to IHS rules and regulations and LIHC policies and procedures.
Possess time management skills.
Knowledge of the tribe’s confidentiality and security policies.
Ability to work as a team member.
Ability to lift, reach, stretch, and bend.
Ability to relate to Native Americans.
MINIMUM QUALIFICATIONS:
- Must have a high school diploma or equivalent from an accredited high school.
- Must have a valid California driver’s license or license from current residence state.
- Must pass pre-employment background check.
- Must pass a pre-employment drug test.
- Must have a valid CPR card or be able to obtain one within ninety (90) days of hire.
- Two-year college degree or completion of a specialized course of study at an accredited
business or trade school. Four years of similar or related experience can be substituted for
education.
WORKPLACE ENVIRONMENT:
PHYSICAL SAFETY: The work is sedentary. Typically, the employee may sit comfortably to
do the work. However, there may be some walking, standing, bending, carrying light items, driving an automobile, etc. No special physical demands are required to perform the work.
WORKING ENVIRONMENT: Regular exposure to favorable conditions such as those found
in a normal office.
PERFORMANCE EXPECTATIONS:
- Uphold all principles of confidentiality.
- Adhere to all professional and ethical behavior standards.
- Interact in an honest, trustworthy and respectful manner with employees, visitors and
vendors. - Participate in departmental staff meetings, quality management activities, cultural and
educational programs. - Comply with policies and procedures.
- Display respect and understanding of Susanville Indian Rancheria’s traditions and values.
- The way the employee relates to fellow employees, customers and visitors is considered
parallel in importance to technical knowledge and ability. - Any attitude or behavior that will tarnish the name or reputation of the Susanville Indian Rancheria will not be tolerated and is subject to disciplinary action.
PREFERENCE POLICY:
1st Preference: Enrolled member of a Federally Recognized Tribe.
2nd Preference: Documented proof of Veteran Status, i.e. DD-214, Veterans Benefit Card.
3rd Preference: All other applicants.
SIR BENEFITS PACKAGE:
The Susanville Indian Rancheria offers its full-time employees a highly competitive benefits package, including: annual cost-of-living increases (based on SSA COLA); eligibility for annual merit increases; twelve paid holidays; thirteen days paid sick leave; up to twenty-six days paid annual leave (depending on length of service); maternity leave; paternity leave; affordable group health, dental, vision, and life insurance; and 401(k) retirement plan.
HOW TO APPLY AND APPLICATION REQUIREMENTS:
All applicants are required to submit a Susanville Indian Rancheria/ Lassen Indian Health Center application. Applications can be found on our website at: www.sir-nsn.gov/human-resources/ (SIR – LIHC – Gaming Commission Application for Employment P.L. 101-630 Requirements) or picked up at 745 Joaquin Street, Susanville, CA.
Only complete applications will be considered. For your application to be considered complete you must attach the following:
- Completed Susanville Indian Rancheria/Lassen Indian Health Center Application.
- Copy of your High School Diploma AND College Degree or transcripts documenting
your graduation or completion of your Degree. - Copy of your valid Driver’s License.
- Copy of any other certifications required.
- Copy of Tribal Card, if claiming Indian Preference.
- Copy of DD214 or other proof of Veteran status, if claiming Veteran’s Preference.
- An additional statement on how you meet each Minimum and Additional Qualification and Knowledge, Skills and Abilities.
Complete applications can be dropped off in person to the Human Resources Office at 745 Joaquin Street, Susanville, California, Monday through Friday from 8:00 am to 5:00 pm. They may also be emailed to [email protected] or faxed to (530) 251-1895 or mailed to the above address. All applications must be received by 5:00 pm Pacific Standard Time on the closing date of the announcement.
