DDD Program Development & Operations Manager (New Jersey))

Infinity Healthcare Services • Princeton, NJ

2d • $25 - $38 • Hybrid

About The Position

Infinity Healthcare Services is seeking an experienced and highly motivated New Jersey DDD Program Development & Operations Manager to lead the development, implementation and growth of the company’s approved New Jersey Division of Developmental Disabilities services. The Program Development & Operations Manager will be responsible for converting Infinity Healthcare Services’ Medicaid and DDD provider approvals into a compliant, sustainable and participant-centered service program. The manager will build the program’s referral network, coordinate participant intake, develop operational procedures, recruit and supervise qualified personnel, monitor service documentation, support accurate Medicaid billing and maintain compliance with applicable DDD, Medicaid and company requirements. This is a hands-on startup and growth position. The successful candidate must be prepared to perform the day-to-day work required to establish the program, rather than solely supervising the work of others. Infinity Healthcare Services is presently approved to provide services that may include Behavioral Management, Community-Based Supports, Career Planning, Individual Supports, Occupational Therapy, Speech, Language and Hearing Therapy, Respite, Physical Therapy and Personal Emergency Response Systems.

Requirements

• Bachelor’s degree in social work, psychology, human services, healthcare administration, business administration or a related field; substantial directly related experience may be considered where permitted.
• At least three years of experience with New Jersey DDD-funded services, Medicaid home- and community-based services, disability services or a closely related human-services program.
• Direct knowledge of the New Jersey DDD Supports Program, Community Care Program, Individualized Service Plans, service authorizations and fee-for-service operations.
• Experience developing or expanding a human-services program.
• Experience with participant intake, staff supervision, service documentation, quality assurance or Medicaid billing.
• Ability to interpret policies and convert them into practical operating procedures.
• Strong organizational, communication, problem-solving and community-relations skills.
• Ability to travel throughout the assigned New Jersey service area.
• Valid driver’s license and reliable transportation.
• Ability to satisfy all required criminal-background, exclusion, licensing and credentialing requirements.

Nice To Haves

• Five or more years of New Jersey DDD provider-agency experience.
• Existing professional relationships with New Jersey support coordination agencies and community partners.
• Experience successfully starting a DDD service line or increasing participant census.
• Experience with Medicaid claims, prior authorizations, electronic visit verification and claim-denial resolution.
• Experience preparing for DDD, Medicaid or licensing audits.
• Experience recruiting and supervising DSPs and licensed clinicians.
• Knowledge of behavioral services, positive behavior supports and person-centered planning.
• Experience developing policies, procedures, forms, audits and quality-management systems.

Responsibilities

• Develop and execute a phased implementation plan for Infinity Healthcare Services’ approved New Jersey DDD services.
• Establish service-specific operating procedures, intake workflows, documentation standards and quality-assurance processes.
• Review applicable DDD Supports Program and Community Care Program requirements and translate those requirements into daily operational practices.
• Assist company leadership in determining service areas, participant capacity, staffing requirements and program-growth priorities.
• Maintain an implementation calendar with measurable launch, census, staffing, compliance and financial objectives.
• Assist with long-term preparation for future residential-service development when the company becomes eligible.
• Establish and maintain professional relationships with New Jersey support coordination agencies, support coordinators, individuals, families, schools, hospitals, clinicians, advocacy organizations and community partners.
• Present Infinity Healthcare Services’ approved services to appropriate referral sources.
• Attend provider fairs, community events, planning meetings and other outreach opportunities.
• Develop and maintain a structured referral pipeline.
• Respond promptly to referral inquiries and maintain professional follow-up until the referral is accepted, declined or closed.
• Ensure all outreach and referral-development activities comply with Medicaid and DDD requirements.
• Review referrals, Individualized Service Plans, assessments, service authorizations and supporting records.
• Confirm participant eligibility, approved services, authorized units, service dates, rates and applicable limitations before services begin.
• Coordinate intake meetings with individuals, families, guardians, support coordinators and planning-team members.
• Evaluate whether Infinity Healthcare Services can safely and appropriately meet each prospective participant’s needs.
• Coordinate qualified staff assignments and establish appropriate service schedules.
• Ensure all required consents, acknowledgments, assessments, emergency information and service documents are completed.
• Monitor pending authorizations and communicate with support coordinators regarding missing or incomplete information.
• Maintain accurate referral, waitlist, admission, transfer and discharge records.
• Identify staffing needs based on authorized participant services and geographic coverage.
• Recruit, interview and recommend qualified DSPs, behavioral professionals, therapists and other personnel.
• Verify education, experience, licenses, certifications, background checks, exclusion screenings and other staff qualifications.
• Coordinate required orientation, DDD training, service-specific training and annual retraining.
• Ensure employees understand participant-specific needs, service plans, documentation requirements, incident-reporting expectations and professional boundaries.
• Establish staffing schedules, backup coverage and procedures for missed or interrupted services.
• Monitor staff attendance, performance, professionalism and service documentation.
• Coordinate personnel matters with company leadership and human resources.
• Develop and maintain compliant service-note templates and documentation instructions.
• Review service records for completeness, accuracy, timeliness and consistency with the participant’s authorized service and Individualized Service Plan.
• Reconcile staff schedules, electronic visit records, service notes, authorizations and claims.
• Monitor utilization to prevent services from exceeding authorized units or service dates.
• Coordinate corrections of incomplete or deficient records before claims are submitted.
• Work with billing personnel to resolve claim rejections, denials, authorization problems and payment discrepancies.
• Maintain organized and audit-ready participant and program records.
• Identify overpayments, billing errors or compliance concerns and immediately report them to executive leadership.
• Maintain working knowledge of applicable New Jersey DDD, Medicaid, HCBS, licensing, incident-reporting and provider requirements.
• Assist in developing, reviewing and implementing the agency’s New Jersey policies and procedures.
• Conduct routine participant-file, personnel-file, service-documentation and billing audits.
• Track complaints, grievances, incidents, investigations and corrective actions.
• Ensure required incidents and concerns are reported within applicable timeframes.
• Coordinate internal investigations and corrective-action plans under the direction of executive leadership.
• Monitor participant health, safety, rights, choice, community integration and satisfaction.
• Prepare the program for DDD, Medicaid and other regulatory reviews.
• Immediately escalate suspected abuse, neglect, exploitation, fraud, billing irregularities or threats to participant health and safety.
• Coordinate behavioral and therapy services with appropriately licensed or credentialed professionals.
• Confirm that clinical personnel operate within their professional scope of practice.
• Ensure clinical assessments, plans, progress notes and supervision satisfy applicable service requirements.
• Maintain separation between administrative oversight and clinical decision-making when the manager does not hold the applicable clinical license.
• Monitor professional licenses, certifications, malpractice coverage and credential expiration dates.
• Develop service-capacity and revenue projections in collaboration with executive leadership.
• Monitor authorized units, delivered units, missed units, billing status and collections.
• Identify operational barriers that affect participant access, service delivery or reimbursement.
• Recommend staffing and service-growth decisions based on participant needs, authorization levels and financial sustainability.
• Avoid unnecessary overhead and build staffing in proportion to confirmed service demand.
• Submit a written weekly report that includes: Referrals received and referral sources, Referrals awaiting information or authorization, Participants admitted and scheduled to begin, Active participants by service, Authorized, scheduled and delivered service units, Open staffing needs and coverage concerns, Documentation deficiencies, Claims submitted, pending, paid or denied, Incidents, complaints and corrective actions, Outreach activities and support-coordinator contacts, Revenue projections and operational risks, Matters requiring executive approval or intervention.

Benefits

• Competitive hourly rate or salary based on experience.
• Performance incentive based on clearly defined and lawful program-development objectives, including successful program implementation, participant service commencement, documentation compliance, staff retention and sustainable program performance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level