PACE Referrals Manager

Position Summary:

Under the general supervision of the PACE Senior Program Director, the Referrals Manager oversees the Referrals Team to ensure adherence to policies, procedures, and PACE regulatory requirements. The role is focused on achieving goals related to the efficient and timely processing of referrals and authorizations to ensure prompt care for PACE participants.

Essential Functions of the Job:

• Develop and implement departmental policies and procedures to meet participant and care team objectives, fostering an efficient and quality-driven environment that meets performance and productivity goals.
• Manage daily operations and oversee the department's work plan, ensuring compliance with regulations, policies, and performance standards.
• Onboard, train, and mentor Referral Specialists on SD PACE/SYH’s mission, vision, values, departmental objectives, and operational workflows.
• Plan, evaluate, and enhance operations, implementing improvements through consultation, staff development, and system upgrades. Form and manage work groups, planning teams, and task assignments as needed.
• Conduct comprehensive staff training to align staff with organizational goals and compliance standards, including competency exams, assessments, and performance reviews.
• Maintain ongoing communication with key stakeholders within SD PACE.
• Integrate referral management with ongoing medical and case management activities.
• Monitor departmental productivity to ensure timely processing of referrals and provide performance reports to leadership.
• Represent SD PACE/SYH professionally and maintain positive relationships with the public, clients, patients, co-workers, and other agencies, ensuring exceptional customer service.

Additional Duties and Responsibilities:

• Analyze referral reports using SDP EMR system.
• Ensure referrals request are completed in a timely manner.
• Provide reports to Referral supervisors and leadership team
• Coverage for Referral Specialist as needed.
• Enable an open environment for feedback.
• Some weekend hours and travel as needed.
• Perform other related duties as assigned or requested.

Job Requirements:

Education Required:

• Required: BA in related field (e.g., health and human services, public administration, business, marketing)
• Preferred: Master’s degree in related field.

Certifications/Licenses Required:

• CA valid driver’s license and reliable transportation
• Proof of current vehicle insurance (if applicable)

Experience Required:

• Minimum of 3 years in medical management for managed care, including claims, referral authorization, and front/back-office duties
• Minimum of 3 years in a supervisory or department lead role.
• Relevant education may substitute for experience.

Experience Preferred:

• Medicare or HMO Health Plan Referral and Authorization leadership experience.
• Essential personal attributes and skills include a strong passion for working on behalf of disadvantaged and vulnerable populations
• Positive and enthusiastic attitude, strong skills in leadership, team building/staff development, critical thinking and problem-solving
• Self-starter that is action-oriented, entrepreneurial, adaptable, and innovative in approach to work
• Sensitivity and respect for diversity, equity and inclusion.
• Experience in a health care setting and/or knowledge about the products, services, standards, policies and procedures in a healthcare Managed Care environment

Verbal and Written Skills Required to Perform the Job:

• Excellent interpersonal, written and presentation skills
• Spanish preferred but not required

Technical Knowledge and Skills Required to Perform the Job:

• Technical writing and data reporting experience (i.e., policies/procedures, data collection and reporting)
• Proficiency in the following programs: Microsoft Office (Word, Excel, Access, PowerPoint)
• Knowledge of products, services, standards, polices and procedures in a healthcare environment

Working Conditions and Physical Requirements:

• Must be able to sit at desk or workstation for extended periods
• Must be able to lift up to 25lbs
• Must be open to working weekends and holidays as needed.

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment.  Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.