PACE Referrals Operations Lead

San Ysidro Health; San Diego (CA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

San Ysidro Health is seeking a Referrals Supervisor to support the PACE referrals process. Under supervision, you will assist referrals specialists, oversee workflow, and ensure adherence to policies and regulatory requirements for timely participant care.

You will lead staff, train on platforms like Epic and QuickCap, prepare management reports, and coordinate cross-site communication with clinic leadership to maintain quality care for PACE participants.

Qualifications

• High school diploma or GED required, plus post-high school vocational training in medical terminology or coding.
• Experience in supervisory roles in medical management (claims/referrals) preferred.

Responsibilities

• Assist in developing and implementing departmental policies and procedures to meet participant and care team objectives.
• Coordinate workload distribution and monitor productivity to meet performance goals.
• Lead investigation of issues impacting referrals and implement workflow changes to improve processes.
• Interpret and communicate changes in workflows and expectations to Referral Specialists.
• Serve as super-user for PACE platforms (Epic, QuickCap) and provide training/optimization support.
• Communicate with internal and external stakeholders regarding referrals, codes, billing, and authorizations.
• Prepare reports for management and may visit PACE sites to liaise with clinic leadership.

Skills

Supervisory experience

Medical terminology

Communication skills

Multitasking

Education

High School Diploma or GED

Medical Terminology/CPT ICD9 coding training or certificate

Tools

MS Office

Electronic Health Record (EHR) systems

Job description

San Ysidro Health is seeking a Referrals Supervisor to support the PACE referrals process. Under supervision, you will assist referrals specialists, oversee workflow, and ensure adherence to policies and regulatory requirements for timely participant care.

You will lead staff, train on platforms like Epic and QuickCap, prepare management reports, and coordinate cross-site communication with clinic leadership to maintain quality care for PACE participants.