Infusion Intake Manager

Oso Home Care•Irvine, CA

19h

About The Position

Oso Home Care, Inc. is seeking an experienced Infusion Intake & Authorization Manager to lead the daily operations of its Intake and Authorization Departments within a specialty home infusion organization. The manager oversees the intake process from initial referral through benefit verification, prior authorization, financial clearance, and patient admission, ensuring requests are processed accurately, efficiently, and in accordance with payer, clinical, regulatory, and company requirements. This position directly oversees the Intake and Authorization teams and works closely with Pharmacy, Nursing, Reimbursement, Billing, Scheduling, Sales, and Clinical teams to facilitate timely admissions and continuity of care. The role requires a hands-on leader able to manage a high-volume, fast-paced environment while maintaining customer service, operational efficiency, financial accuracy, and regulatory compliance.

Requirements

High school diploma or equivalent required.
Minimum 1 year of supervisory or management experience in a healthcare environment required.
Experience with insurance verification, eligibility, prior authorization, authorization renewals, and financial clearance processes.
Working knowledge of commercial insurance, Medicare, Medicaid/Medi-Cal, managed care, and other healthcare payer requirements.
Understanding of healthcare revenue-cycle operations and the financial impact of intake and authorization decisions.
Knowledge of HIPAA, CMS requirements, healthcare compliance, and accreditation standards such as ACHC.
Demonstrated ability to coach, develop, and hold employees accountable.
Strong organizational and time-management skills, including the ability to manage competing priorities and deadlines.
Strong analytical, critical-thinking, problem-solving, and decision-making abilities.
Excellent written and verbal communication skills.
Strong interpersonal and customer-service skills and ability to work effectively with patients, referral sources, healthcare professionals, payers, employees, and leadership.
Proficiency with Microsoft Office Suite and electronic healthcare documentation systems.

Nice To Haves

Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Nursing, or a related field.
Home infusion, specialty pharmacy, home health, infusion intake, authorization, or related healthcare experience.
Understanding of infusion therapies, specialty medications, medical necessity requirements, and payer qualification criteria.
Familiarity with infusion pharmacy software, electronic medical records, hospital referral portals, payer portals, and electronic referral systems.
Direct experience managing a home infusion or specialty pharmacy Intake and/or Authorization team.
Experience managing high-volume referral and authorization workflows.
Experience working with payer portals, hospital referral portals, insurance carriers, PBMs, physician offices, hospital discharge planners, and case managers.
Knowledge of infusion therapy benefits, payer qualification requirements, medical necessity criteria, and authorization processes.
Experience managing initial authorizations, reauthorizations, authorization renewals, and expiring authorizations.
Experience developing and monitoring departmental KPIs, productivity standards, dashboards, and performance reports.
Experience with quality improvement and process improvement initiatives.
Strong understanding of the relationship between intake, authorization, reimbursement, billing, collections, denials, and revenue-cycle performance.
Demonstrated ability to improve workflow efficiency, referral turnaround times, and authorization performance.
Ability to lead effectively in a fast-paced, deadline-driven healthcare environment.

Responsibilities

Provide leadership, direction, coaching, training, and performance management for the Intake and Authorization Departments.
Oversee the intake process from referral receipt through benefit verification, authorization, financial clearance, and admission.
Directly oversee the Authorization Department and ensure initial and ongoing authorization requests are submitted accurately and on time.
Monitor authorization workflows, pending and expiring authorizations, renewals, payer requests, and follow-ups to prevent interruptions in patient therapy.
Ensure authorization staff obtain and maintain required clinical documentation, physician orders, medical necessity information, and other payer-required documentation.
Establish processes to identify authorization expirations and renewal requirements proactively.
Work with Pharmacy, Nursing, Reimbursement, and clinical staff to obtain updated documentation needed for authorizations or extensions.
Monitor incoming referrals for timely response, follow-up, and conversion of qualified referrals to admissions.
Ensure accurate entry and maintenance of patient, referral, physician order, insurance, clinical, and authorization information.
Oversee insurance benefit verification, eligibility, prior authorization, payer requirements, and financial clearance for infusion therapies.
Review payer requirements and therapy-specific coverage criteria to determine qualification and reimbursement requirements.
Coordinate new patient admissions across Pharmacy, Nursing, Scheduling, Reimbursement, Billing, Authorization, and Clinical teams.
Collaborate with hospital case managers, discharge planners, physician offices, healthcare providers, and referral sources to facilitate transitions to home infusion services.
Manage hospital referral portals, electronic referral systems, fax queues, and other referral channels.
Communicate with referral sources regarding referral status, missing documentation, authorization requirements, and admission coordination.
Serve as a liaison among Sales/Marketing, Intake, Authorization, Pharmacy, Nursing, Scheduling, Reimbursement, and Billing to improve communication and resolve operational barriers.
Partner with Reimbursement and Billing teams on insurance, authorization, eligibility, denial, and payment issues affecting admission or reimbursement.
Understand reimbursement methodologies and the financial effects of intake and authorization decisions on billing, collections, denials, and revenue-cycle performance.
Monitor referral volumes, turnaround times, pending referrals, authorization status and turnaround times, expiring authorizations, conversion rates, productivity, and other KPIs.
Develop and maintain departmental metrics, dashboards, and quarterly performance reports for Intake and Authorization.
Analyze referral, authorization, and workflow trends to identify risks and improvement opportunities.
Prepare and present departmental performance and operational reports to leadership.
Identify workflow inefficiencies and implement process improvements to increase productivity, accuracy, quality, and speed to admission.
Establish and maintain standardized Intake and Authorization procedures and ensure staff follow workflows.
Oversee outsourced intake, authorization, and reimbursement vendor relationships and workflows, including adherence to company expectations and applicable Business Associate Agreement requirements.
Respond promptly and professionally to concerns from patients, referral sources, physician offices, payers, and internal customers.
Escalate clinical, payer, operational, financial, or compliance concerns when necessary.
Ensure departmental practices comply with HIPAA, CMS requirements, applicable state and federal regulations, accreditation standards, payer requirements, and company policies.
Participate in departmental planning, strategic initiatives, quality improvement, and organizational performance improvement projects.
Perform additional duties and responsibilities as assigned.