PACE Referrals Manager
PACE Referrals Manager
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Job Description
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 qualitydriven environment that meets performance and productivity goals.
- Manage daily operations and oversee the departments work plan ensuring compliance with regulations policies and performance standards.
- Onboard train and mentor Referral Specialists on SD PACE/SYHs 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 coworkers 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: Masters degree in related field.
Experience Required:
- Minimum of 3 years in medical management for managed care including claims referral authorization and front/backoffice 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 problemsolving
- Selfstarter that is actionoriented 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:
Preemployment requirements include I9 physical positive background and reference check results complete application new hire orientation preemployment 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 108000 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 missiondriven team! San Ysidro Health has a longstanding 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 HIVrelated 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.
Other details
- Pay TypeSalary
- Min Hiring Rate$39.93
- Max Hiring Rate$53.05
Required Experience:
Manager
Employment Type
Full-Time
