PRC Program Manager: Healthcare Benefits & Compliance

The-Coquille-Indian-Tribe; Coos Bay (OR); On-site; USD 90,000 - 120,000; Full time

Job summary

The Coquille Indian Tribe seeks a seasoned professional to oversee Purchased & Refere d Care (PRC) administration within the Health & Wellness Division. This role leads the PRC Registration Specialist, guiding budgets, audits, and policy development to ensure compliant, efficient service delivery.

Responsibilities include program administration, claims auditing, and stakeholder coordination, with travel as needed to support tribal healthcare operations and partnerships.

Qualifications

• Strong leadership and supervisory experience in public health/medical outpatient settings.
• Knowledge of Medicaid/Medicare and private health insurance.
• Familiarity with HIPAA privacy and confidentiality guidelines.
• Ability to develop budgets, contracts, grants, and program evaluation.
• Current driver’s license in good standing.

Responsibilities

• Coordinate and oversee PRC Registration activities and PRC data systems.
• Administer the PRC program including pre-authorizations, pre-obligations and denials.
• Audit claims for payments and pursue alternate resources.
• Develop and administer budgets and grant reporting for the Health & Wellness Division.
• Collaborate with IT and external partners to ensure efficient system work processes.

Skills

Verbal communication

Written communication

Team building

Problem solving

Interpersonal skills

Budget management

Grant administration

Decision making

Stakeholder management

Education

Associate’s degree in Public Health or related field

Job description

The Coquille Indian Tribe seeks a seasoned professional to oversee Purchased & Refere d Care (PRC) administration within the Health & Wellness Division. This role leads the PRC Registration Specialist, guiding budgets, audits, and policy development to ensure compliant, efficient service delivery.

Responsibilities include program administration, claims auditing, and stakeholder coordination, with travel as needed to support tribal healthcare operations and partnerships.