San Ysidro Health
Job Description
Posted Tuesday, December 30, 2025 at 11:00 AM Position Summary
Under the direct supervision of the PACE Referrals Manager, the Referrals Supervisor assists the Referrals Specialists 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
Assists in the development and implementation of departmental policies and procedures to meet participant and care team objectives, fostering an efficient and quality-driven environment that meets performance and productivity goals. Coordinates the distribution of workload to ensure efficiency and ongoingly monitors productivity. Takes the lead in the investigation of issues impacting the referral process and/or PACE participants care. When necessary, implements changes in the workflow to improve the referrals process. Interprets and communicates changes in workflows, policies and expectations to the Referral Specialists while setting clear expectations. Functions as a super-user for all PACE platforms (i.e. Epic, QuickCap) that interact with the PACE referral process. Acts as an ongoing resource for training and optimization initiatives for the platforms. Communicates frequently with internal and external stakeholders to assist with inquiries surrounding referrals, treatment codes, billing, authorizations. Maintains oversight of all platforms to ensure all related data is accurate to assist in generating reports. Ongoingly communicates with specialty offices to provide updates regarding changes to maintain a positive relationship to enhance our PACE participants care. Interviews, hires, performs disciplinary action and performance evaluations for employees and maintains their schedules and time-off requests, including weekly edits as appropriate. Leads regular meetings to disseminate updates and to discuss any issues throughout the department. Attends meetings as required and participates in committees as directed. Prepares reports requested by management. May visit different PACE sites to maintain open communication with clinic leadership and staff. Additional Duties and Responsibilities
Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops. Coverage for Referral Specialist as needed. Encourages creative thinking, problem solving, and empowerment as part of the facility management group to improve morale and teamwork. Works closely with PACE leadership to enhance the referrals department’s efficiency. Performs other related duties as assigned or requested Job Requirements
Education Required (Minimum level of education)
High School Diploma or GED Equivalent Post High School Vocational/Specialized Training (Medical Terminology, CPT/ICD9 coding, Medical Assistant Certificate or Certified Procedural Coder Certificate) Education Preferred
Bachelor’s degree in healthcare related field Experience Required (Minimum level of experience)
Minimum 6 months of supervisory experience in medical management for managed care related field, such as claims, referral authorization, and front/back office. Preferred: 1 year of supervisory related duties in related fields. Verbal and Written Skills Required to Perform the Job
Excellent oral and written communication skills. Technical Knowledge and Skills Required to Perform the Job
Medical Terminology and working knowledge of Microsoft Windows, MS-Office. Knowledge of program and health plan eligibility, coding, data processing, and medical records. Ability to handle multiple activities simultaneously and able to prioritize work. Equipment Used
Personal computer Electronic Health Record system or computerized referral system. Telephone devices and voicemail. Working Conditions and Physical Requirements
Prolonged periods of sitting, minimum walking, and constant telephone communication. May be required to work evenings, holidays or weekends. 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.
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Posted Tuesday, December 30, 2025 at 11:00 AM Position Summary
Under the direct supervision of the PACE Referrals Manager, the Referrals Supervisor assists the Referrals Specialists 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
Assists in the development and implementation of departmental policies and procedures to meet participant and care team objectives, fostering an efficient and quality-driven environment that meets performance and productivity goals. Coordinates the distribution of workload to ensure efficiency and ongoingly monitors productivity. Takes the lead in the investigation of issues impacting the referral process and/or PACE participants care. When necessary, implements changes in the workflow to improve the referrals process. Interprets and communicates changes in workflows, policies and expectations to the Referral Specialists while setting clear expectations. Functions as a super-user for all PACE platforms (i.e. Epic, QuickCap) that interact with the PACE referral process. Acts as an ongoing resource for training and optimization initiatives for the platforms. Communicates frequently with internal and external stakeholders to assist with inquiries surrounding referrals, treatment codes, billing, authorizations. Maintains oversight of all platforms to ensure all related data is accurate to assist in generating reports. Ongoingly communicates with specialty offices to provide updates regarding changes to maintain a positive relationship to enhance our PACE participants care. Interviews, hires, performs disciplinary action and performance evaluations for employees and maintains their schedules and time-off requests, including weekly edits as appropriate. Leads regular meetings to disseminate updates and to discuss any issues throughout the department. Attends meetings as required and participates in committees as directed. Prepares reports requested by management. May visit different PACE sites to maintain open communication with clinic leadership and staff. Additional Duties and Responsibilities
Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops. Coverage for Referral Specialist as needed. Encourages creative thinking, problem solving, and empowerment as part of the facility management group to improve morale and teamwork. Works closely with PACE leadership to enhance the referrals department’s efficiency. Performs other related duties as assigned or requested Job Requirements
Education Required (Minimum level of education)
High School Diploma or GED Equivalent Post High School Vocational/Specialized Training (Medical Terminology, CPT/ICD9 coding, Medical Assistant Certificate or Certified Procedural Coder Certificate) Education Preferred
Bachelor’s degree in healthcare related field Experience Required (Minimum level of experience)
Minimum 6 months of supervisory experience in medical management for managed care related field, such as claims, referral authorization, and front/back office. Preferred: 1 year of supervisory related duties in related fields. Verbal and Written Skills Required to Perform the Job
Excellent oral and written communication skills. Technical Knowledge and Skills Required to Perform the Job
Medical Terminology and working knowledge of Microsoft Windows, MS-Office. Knowledge of program and health plan eligibility, coding, data processing, and medical records. Ability to handle multiple activities simultaneously and able to prioritize work. Equipment Used
Personal computer Electronic Health Record system or computerized referral system. Telephone devices and voicemail. Working Conditions and Physical Requirements
Prolonged periods of sitting, minimum walking, and constant telephone communication. May be required to work evenings, holidays or weekends. 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.
#J-18808-Ljbffr