PACE Referral & Medical Records Supervisor (Central Valley PACE - Ceres Whitmore)

Oversees a team responsible for referral coordination authorizations scheduling medical records and regulatory compliance within the PACE Health Plan. Ensures smooth health plan operations manages workflows supports data-driven decision making and contributes to audit readiness and compliance with Centers for Medicare & Medicaid Services (CMS) Department of Health Care Services (DHCS) and other regulatory bodies.

Located at Central Valley PACE Ceres CA

Schedule is Monday Friday working from 8:00am 5:00pm

Compensation: $29.94 $31.43 an hour.

Duties and Responsibilities

• Supervise Health Plan Specialists and support staff in scheduling authorizations and medical records.
• Establish monitor and improve workflows for scheduler and medical records teams.
• Ensure all tasks are completed per policies and regulatory requirements.
• Provide ongoing training and support to staff; resolve escalated scheduling and coordination issues.
• Collaborate across departments especially with transportation day center and clinic teams.
• Manage creation and reconciliation of network referrals authorizations and schedules.
• Monitor delivery of participant services and satisfaction.
• Maintain and update Electronic Health Record (EHR) with authorization transportation and scheduling information.
• Monitor contacts of participants and caregivers for appointment confirmations and follow-ups.
• Assist with compliance monitoring for CMS DHCS and other regulatory standards.
• Develop and maintain Standard Operating Procedures (SOPs) and departmental documentation for audits and ongoing improvement.
• Submit documentation to CMS (via Health Plan Management System) and maintain reporting structure per regulatory contracts.
• Coordinate cost report preparation survey submissions and pro forma analysis.
• Perform data analysis to support outcome-based decisions and financial impact assessments.
• Track and interpret trends in participant services and operational performance.
• Collaborate with Quality and Compliance teams to address risks and implement performance improvement initiatives.
• Assist in preparation for audits and ensure department readiness through organized documentation.
• Monitor participant status for changes and report to licensed staff.
• Interact professionally with frail or elderly individuals including those with cognitive decline or physical limitations.
• Complete other duties or special projects as assigned.

Physical Demands

• Ability to lift up to 30 pounds. Moving lifting or pushing greater than 30 pounds should be done with assistance as appropriate.
• Must be able to hear staff on the phone and those who are served in-person and speak clearly in order to communicate information to clients and staff.
• Must have vision with or without lenses that is adequate to read memos a computer screen personnel forms and clinical and administrative documents.
• Must have high manual dexterity.
• Must be able to reach above the shoulder level to work must be able to bend squat and sit stand stoop crouching reaching kneeling twisting/turning fingering and feeling.

Work Environment

• Exposure to biohazards including infectious material and waste and any other conditions common in a health care environment.
• The noise level in the work environment is usually quiet to moderate but may at times be noisy and crowded.

Education/Experience Requirements

Minimum Qualifications

• Valid California Drivers License acceptable driving record vehicle insurance and reliable transportation.
• Bilingual English / Spanish preferred.
• Demonstrates excellent written and verbal communication.
• Able to communicate effectively with individuals and groups representing diverse perspectives.
• Proficient in Microsoft Office Outlook PowerPoint and word; advanced Excel and data modeling preferred.
• Ability to independently problem solve with analysis and critical thinking skills.

Education/Experience

• High School Diploma or equivalent.
• Associate degree in business or healthcare preferred.
• Minimum two (2) years Health Plan processes compliance and reporting experience required.
• One (1) year of Supervisor experience.
• Two (2) years experience in claims referrals compliance or billing/coding preferred.

Required Experience:

Manager