PACE Referrals Specialist

PACE Referrals Specialist Full-Time | Onsite | Riverside, CA About the Organization We are working with a private, nonprofit 501(c)(3) community health organization delivering over 500,000 medical, dental, and behavioral health visits to more than 100,000 people each year. Our PACE (Program of All-Inclusive Care for the Elderly) program is a managed medical plan that surrounds participants with a team of physicians, nurses, social workers, therapists, and care coordinators.

Our goal is to help seniors stay healthy and happy at home, surrounded by family and community. With two PACE centers in Riverside County, the program is positioned to serve over 650 senior participants. Role Overview The Referrals Specialist coordinates all referrals and follow-up care for PACE participants. This includes receiving, processing, scheduling, and following up on all medical referral requests, both in-house and outside, for diagnostic testing, medical specialists, and other providers.

Schedule & Location Hours: Monday–Friday, 8:00am–4:30pm Riverside, CA. This position is fully onsite.

Responsibilities

Participant Care Coordination Serve as the main point of contact for providers and clinic staff on referrals, authorizations, and appointment scheduling Prepare, process, and complete referrals accurately and on time, including urgent and stat referrals Arrange transportation for participants to internal and external medical appointments, including escort coordination Communicate referral details and appointment instructions to participants and their families Track referrals in designated logs and in the electronic medical record (EMR) Follow up on submitted authorization requests, maintain status updates in the EMR, and escalate issues until the referral loop is closed Complete surgery scheduling with proper CPT codes and all follow-ups, including pre/post orders, labs, EKGs, and imaging Manage re-authorizations across all payors, working with clinical teams to prevent lapses or delays in care Review consultation reports for needed follow-up and work with providers to process them promptly Partner with Health Information to retrieve consultation reports on time Reschedule missed appointments and notify providers per no-show policies Arrange retrieval of CD images for specialists so appointments are kept and completed Submit retro-authorizations and distinguish between primary care and internal specialty visits Document all actions in the participant record in line with clinic, DHCS, and CMS guidelines Explain the referral process to participants as needed or requested by the treating provider Handle referral-related calls, texts, patient portal messages, and mail Act as liaison between participants, clinic providers, specialists, hospitals, and community resources Provider & Team Support Obtain referrals and authorizations from providers in a timely manner Communicate referral, authorization, and pertinent medical information to specialty providers Participate in scheduled department meetings Share accountability for participant health outcomes alongside care teams Customer Relations Maintain professional relationships with staff, participants, families, referral sources, and the public Work as part of a team to meet department goals Qualifications High school diploma or GED required One year of clinical or healthcare experience required Referral authorization and data processing experience preferred One year of experience working with elderly populations preferred Bilingual English/Spanish highly preferred Valid Basic Life Support (BLS) certification required, or candidate must be willing to obtain if hired.

We can assist with this process during onboarding. CPR and First Aid certification required for all PACE employees per CMS and DHCS requirements. First Aid training is provided at onboarding and renewed annually. Skills & Abilities Excellent verbal and written communication, with strong typing and proofreading skills Working knowledge of CPT, ICD-10, and medical terminology Ability to interpret written, oral, diagram, and schedule-based instructions Strong planning and organizational skills; able to juggle multiple tasks Works well both independently and as part of a team Handles highly confidential information professionally and ethically Physical Requirements Ability to lift/carry 10 lbs Ability to stand for long periods Compensation & Benefits Pay range: $22–$32 per hour, depending on experience.

Final placement within the range is based on skills, experience, market data, and internal equity.

Benefits

include medical, dental, and vision; two-plus weeks of vacation; nine holidays (including two floating); sick/personal time; volunteer time off; a 403(b) retirement plan; and wellness events.