PACE Manager, Utilization and Referral Services

For more than55 years, Family Health Centers of San Diego's (FHCSD) mission has been to provide caring, affordable, high-quality health care and supportive services to everyone, with a special commitment to uninsured, low-income and medically underserved persons.

FHCSD is one of the top 10 largest federally qualified health centers (FQHCs) in the country. We operate more than 90 sites across San Diego County, including 29 primary care clinics, 23 behavioral health facilities, 10 physical rehabilitation clinics, nine dental clinics, five vision clinics, four outpatient substance use treatment programs, three mobile medical units, two mobile counseling centers, two urgent care centers, and a pharmacy.

Our staff provides care to over 227,000 patients each year, of whom 91% are low-income and 29% are uninsured. FHCSD provides care to all. Services include, but are not limited to adult care, chronic disease management, pediatrics, comprehensive women's care including obstetrics, dental, vision, case management, physical rehabilitation, speech therapy for children, vaccinations, infectious diseases, behavioral health, substance use counseling and a host of specialty services including cardiology, podiatry, endocrinology, dermatology, among others. FHCSD also offers supportive services to those who are unsheltered and in need of intensive case management.

The breadth of our clinic locations, services and programs has grown over the last five decades, making us the largest community clinic provider of health care to the uninsured in the county and one of the top 10 largest community clinic organizations in the nation. We are also the largest health care safety-net provider, largest school-based health care provider and the largest mental health provider in the San Diego region.

Job Summary
The Manager, Utilization and Referral Services is responsible for leading and overseeing all referral and scheduling operations for the PACE (Program of All-Inclusive Care for the Elderly) program. This role ensures timely access to care, efficient coordination of services, and strict compliance with federal PACE regulations (42 CFR Part 460) and California Department of Health Care Services (DHCS) requirements.

Job Description

The Manager, Utilization and Referral Services provides guidance to referral and scheduling staff and partners closely with PACE Assistant Medical Director, with the Interdisciplinary Team (IDT) attending daily IDT meetings, with the Compliance Manager, with leadership in Clinical Operations, , Transportation, and IT, and plays a critical role in ensuring participant-centered, compliant, and efficient service delivery across the continuum of care.

Job Roles

Regulatory Compliance

• Ensure departmental operations comply with CMS PACE regulations (42 CFR Part 460), including requirements related to assessments, care planning, timeliness, and interdisciplinary team coordination.
• Works in close collaboration with PACE Assistant Medical Director to monitor utilization patterns in line with quality indicators to optimize referral authorizations.
• Works with referrals and scheduling staff providing guidance as it applies to referrals, scheduling, and access to care.
• Support compliance with PACE requirements for timeliness of referrals authorizations and scheduling of specialty appointments.
• Maintain accurate documentation and reporting required for CMS and DHCS audits, surveys, and monitoring activities.
• Partner with the Compliance Manager to identify, investigate, and resolve potential compliance risks related to referral and scheduling workflows.
• Works in close collaboration with QA Coordinator to monitor service delivery requests and grievances related to denials.

Referral & Intake Management

• Supervise referral and scheduling staff responsible for receiving referrals, reviewing, authorizing, and scheduling appointments.
• Establish and monitor referral performance standards, including time to first contact and time to schedule specialists' appointments.
• Maintain strong relationships with the various interdisciplinary team and primary care providers, as well as external clinical providers such as hospitals and specialists.

Scheduling & Access Operations

• Lead all specialty care scheduling operations and transportation.
• Develop and maintain scheduling templates, rules, and workflows that support timely access to care and compliance with PACE requirements.
• Supervise scheduling staff and ensure effective coordination among clinical providers, transportation services, and external partners.
• Monitor appointment availability, utilization, cancellations, and no-show trends; implement corrective strategies as needed.
• Coordinate daily or routine scheduling huddles to address urgent needs, provider availability changes, and participant issues.
• Ensure accurate and timely data entry in CMIS and PACE dashboard.
• Develop and analyze reports related to referral volume, scheduling performance, and access metrics.
• Track and report key indicators such as wait times and appointment adherence.
• Identify trends, gaps, and operational risks; lead or participate in quality improvement initiatives.
• Address escalated participant, caregiver, and referral partners concerns related to access, scheduling, or authorizations.
• Ensure clear communication with participants and caregivers regarding appointment schedules and processes.
• Support outreach and education efforts related to referral processes and PACE services.

Requirements:

• Bachelor's degree in healthcare administration, public health, business administration, or a related field (Master's degree preferred).
• Traveling between sites and other locations is required as an essential function of the job. Must have a car, a valid California driver's license, and proof of minimum levels of car insurance as required under California law, although limits of $100,000 are recommended. An acceptable driving record is also required. California law requires all drivers to obtain a valid California driver's license within ten days of establishing residency. Mileage and other reimbursement governed by policy.

Experience/Specialized skills (including Language)

• Minimum of 3-5 years of healthcare operations or management experience required, preferably in PACE, managed care, Medicaid, or geriatric services.
• Demonstrated knowledge of PACE regulations, CMS requirements, and California Medi-Cal/DHCS guidelines.
• Experience managing referrals, intake, scheduling, or access-to-care operations.
• Proven leadership and staff management experience.
• Experience working directly in a PACE program or with frail elderly populations.
• Familiarity with interdisciplinary team models of care.
• Experience with EHR and scheduling systems used in managed care or PACE environments.
• Strong organizational and analytical skills
• Excellent communication and interpersonal abilities
• Ability to interpret and apply complex regulations.
• Process improvement and critical thinking skills.
• Commitment to participant-centered, culturally competent care

Rewards:

• Job type: Regular Full Time

• Competitive Salary with Excellent Benefits

• Retirement Plan with Employer Match

• Paid Time Off, Extended Sick Leave, and Paid Holidays

• Medical/Dental/Vision/FSA/Life Insurance

• Employee Discounts and Wellness Programs

#IndPACE

We are excited to share that the salary range for this position is:

Information on our extensive benefits package can be found here: FHCSD Wellness - Employee Hub (gobenefits.net)

FHCSD provides Equal Employment Opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, transfer, leave of absence, compensation, and training.