PACE Referral Specialist

Pace Referral Specialist

Eastridge Workforce Solutions is committed to connecting skilled professionals with meaningful career opportunities. We are seeking a PACE Referral Specialist to support our client's team. Location: Riverside, CA

Pay range: $24-27 p/h Employment Type: Temp-to-hire FLSA Status: Non-exempt Schedule: M-F 8 am to 5 pm Direct Patient Care

• Serves as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling
• Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned PACE location
• Arranges transportation for participants to medical appointments at Neighborhood and other organizations, including escort coordination
• Communicates referral details and appointment information/instructions to participants and their families
• Tracks referrals in the designated logs and/or electronically via electronic medical records (EMR)
• Follows up on submitted authorization requests and maintains consistent status updates via EMR
• Monitors and reports on statuses of authorization requests; escalates issues as necessary until fully resolved and referral loop is closed
• Completes surgery scheduling with proper CPT codes and all needed follow ups, including pre and post order management, labs, EKG, images, etc.
• Manages needs for re-authorization across all clients and payors by working with clinical teams to ensure timeliness re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care
• Reviews consultation reports for needed follow up requests and works with providers to ensure timely processing of all follow ups
• Works with the health information department to ensure timely retrieval of consultation reports
• Reschedules missed appointments and notifies the provider according to no show policies
• Arranges the retrieval of CD images and provides to medical specialist to ensure appointment are kept and completed
• Submits retro-authorizations and distinguishes between primary care and internal specialty visits
• Documents all actions taken in the participant medical record in accordance with current Clinic, DHCS and CMS regulations/guidelines
• Advocates and discusses with participants all aspects of the referral process as needed or requested by the treating provider
• Screens and answers related referral calls by telephone, text message, patient portal, and/or by mail
• Acts as a liaison between participant, clinic/providers, specialty care providers, hospitals, and other community resources

QualificationsEducation/Experience

• High school diploma/GED required
• One year of clinical or healthcare experience required
• Experience with referral authorization and data processing preferred
• One year of experience working with elderly populations preferred
• Bilingual (English/Spanish) is highly preferred
• Current Basic Life Support (BLS) certification is required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines, but may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards

Benefits: Eastridge Workforce Solutions offers the following benefits, subject to applicable eligibility requirements. Use this link to learn more about benefits available to Eastridge's temporary employees. Due to the varying length(s) of temporary assignments, Eastridge Workforce Solutions' Temporary Staff are not eligible for paid time off, unless required by applicable state law in which the position is based. However, from time to time Eastridge's clients may offer additional benefits to Eastridge employees while on assignment. Information about those benefits will be communicated when applicable. Disclaimer: The compensation and benefits information in this posting represents Eastridge's good faith and reasonable estimate of what it might pay for this position. Eastridge reserves the right to modify this information at any time, subject to applicable law. Equal Opportunity Employer: Eastridge Workforce Solutions is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity, and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, gender expression, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Eastridge Workforce Solutions also prohibits harassment or retaliation of applicants or employees based on any of these protected categories. It is our policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions. Please note that Eastridge is unable to provide visa sponsorship to applicants. Background Checks: Certain clients require Eastridge Workforce Solutions to perform background checks. Eastridge will consider qualified applicants with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the California Fair Chance Act, the Los Angeles City Fair Chance Ordinance, Los Angeles County Fair Chance Ordinance for Employers, and the San Francisco Fair Chance Ordinance. Massachusetts Candidates: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Privacy: Information collected and processed as part of your candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Eastridge's Privacy Policy, as well as Eastridge's Pre-Use Notice of Collection and Automated Decision-Making Technologies