Impact Lives, Impact Community

Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in the country. With over 62 sites, over 227,000 patients, and over 417,000 visits last year, we provide a wide variety of health care and outreach services to a very diverse patient population. We are proud of our mission, our lasting community impact, and the cultural and individual diversity of our staff.

Job Profile Summary

The PACE Referral Specialist, Lead is responsible for overseeing the Referrals Team to ensure adherence to policies, procedures, and PACE regulatory requirements. This role will provide day to day direction with the primary focus of achieving goals related to the efficient and timely processing of referrals and authorizations by the team to ensure prompt care for PACE participants.

Job Description

Job Profile Summary

The PACE Referral Specialist, Lead, is responsible for overseeing the Referrals Team to ensure adherence to policies, procedures, and PACE regulatory requirements. This role will provide day to day direction with the primary focus of achieving goals related to the efficient and timely processing of referrals and authorizations by the team to ensure prompt care for PACE participants.

Job Roles

• Manage daily operations and oversee the department's work plan, ensuring compliance with regulations, policies, and performance standards.
• 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.
• Conduct comprehensive staff training to align staff with organizational goals and compliance standards, including competency exams, assessments, and performance reviews.
• 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.
• Monitor departmental productivity to ensure timely processing of referrals and provide performance reports to leadership.
• Onboard, train, and mentor Referral Specialists on SD PACE/SYH's mission, vision, values, departmental objectives, and operational workflows.
• Performs other duties as assigned.

Education/Certifications/Licenses/Registrations

• Required: BA in related field (e.g., health and human services, public administration, business, marketing).
• CA valid driver's license and reliable transportation.
• Proof of current vehicle insurance (if applicable).

Experience/Specialized skills (including Language)

• 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.
• Ability to use strong organization and time-management skills to multi-task, while ensuring accuracy, in order meet changing priorities in a fast-paced, high-workload environment.
• Demonstrated ability to meet deadlines and achieve goals.
• Demonstrated experience utilizing de-escalation and service recovery skills and techniques.
• Capable of leading without authority to provide guidance and mentorship for colleagues.
• Advanced knowledge of insurance providers, portals, and prior authorization requirements.
• Intermediate computer literacy and ability to adapt to new systems seamlessly.
• Clinical knowledge of medical terminology, medical procedures, CPT, and ICD-9 (10).
• Ability to communicate effectively, both verbally and in writing.
• Bilingual in Spanish/English preferred.
• Ability to work effectively with patients from diverse social, cultural and economic groups.
• Able to maintain good working relationships with employees, coworkers, and departments.

Physical Requirements/Working Environment

Bending (neck): FREQUENTLY (3 - 6 HRS)

Bending (waist): OCCASIONALLY (1 - 3 HRS)

Carrying 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Carrying 11 - 25 lbs: NEVER

Carrying 25 - 50 lbs: NEVER

Carrying 51 - 75 lbs: NEVER

Carrying 75 lbs: NEVER

Climbing (ladder): NEVER

Climbing (stairs): RARELY (0-1 HRS)

Driving: To drive from one clinic or another, or in the community: NEVER

Exposure to blood borne pathogens and biohazards: NO

Exposure risk to aerosol-transmitted diseases-YES

Exposure to dust, gas, fumes, or chemicals: OFFICE SUPPLIES

Fine manipulation: FREQUENTLY (3 - 6 HRS)

Kneeling: NEVER

Lifting 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Lifting 11 - 25 lbs: NEVER

Lifting 25 - 50 lbs: NEVER

Lifting 51 - 75 lbs: NEVER

Lifting over 75 lbs: NEVER

Power Grasping: RARELY (0-1 HRS)

Pulling 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Pulling 11 - 25 lbs: NEVER

Pushing 25 - 50 lbs: NEVER

Pushing 51 - 75 lbs: NEVER

Pushing over 75 lbs: NEVER

Reaching (above shoulder level): RARELY (0-1 HRS)

Reaching (below shoulder level): RARELY (0-1 HRS)

Repetitive use of hand: CONSTANTLY (6+ HRS)

Simple Grasping: FREQUENTLY (3 - 6 HRS)

Sitting: CONSTANTLY (6+ HRS)

Standing: OCCASIONALLY (1 - 3 HRS)

Twisting: NEVER

Use of Personal Protective Equipment: NO

Walking: OCCASIONALLY (1 - 3 HRS)

Working around equipment and machinery: Office Equipment

Ages of Patients Served: ALL

In the spirit of pay transparency, we are excited to share the base range for this position, exclusive of fringe benefits or potential bonuses.

If you are hired at Family Health Centers of San Diego, your final base salary compensation will be determined based on factors such as geographic location, jurisdictional requirements, skills, education, and/or experience. In addition to these factors - we believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please keep in mind that the range mentioned above is what we reasonably expect to pay for the role. Hiring at the maximum of the range would not be typical in order to allow for future and continued salary growth. We also offer a generous compensation and benefits package (more information on our benefits offerings is available here: FHCSD Wellness - Employee Hub (gobenefits.net)