PACE Manager, Utilization and Referral Services

For more than 55 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, can