Infusion Intake Manager

Oso Home Care, Inc. is seeking an experienced Infusion Intake & Authorization Manager to lead the daily operations of our Intake and Authorization Departments within our specialty home infusion organization.

The Infusion Intake & Authorization Manager is responsible for overseeing the intake process from initial referral through benefit verification, prior authorization, financial clearance, and patient admission, ensuring referrals and authorization requests are processed accurately, efficiently, and in accordance with payer, clinical, regulatory, and company requirements. This position provides direct oversight of both the Intake and Authorization teams and works closely with Pharmacy, Nursing, Reimbursement, Billing, Scheduling, Sales, and Clinical teams to facilitate timely patient admissions and continuity of care. The ideal candidate is a strong, hands‑on leader with experience in home infusion, specialty pharmacy, healthcare intake, insurance verification, prior authorization, and referral management. This individual must be able to manage a high-volume, fast‑paced environment while maintaining excellent customer service, operational efficiency, financial accuracy, and regulatory compliance.

Essential Responsibilities

• Provide leadership, direction, coaching, training, and performance management for the Intake and Authorization Departments.
• Oversee the complete intake process from referral receipt through benefit verification, authorization, financial clearance, and admission.
• Directly oversee the Authorization Department, ensuring initial and ongoing authorization requests are submitted accurately and within required timeframes.
• Monitor authorization workflows, pending authorizations, expiring authorizations, renewals, payer requests, and follow-up activities to prevent interruptions in patient therapy.
• Ensure authorization staff obtain and maintain required clinical documentation, physician orders, medical necessity information, and other documentation required by payers.
• Establish processes to proactively identify authorization expirations and renewal requirements to minimize treatment delays and prevent avoidable denials.
• Work with Pharmacy, Nursing, Reimbursement, and clinical staff when updated documentation is required to obtain or extend authorization for infusion therapy.
• Monitor incoming referrals to ensure timely response, appropriate follow-up, and efficient conversion of qualified referrals to admissions.
• Ensure accurate entry and maintenance of patient demographics, referral information, physician orders, insurance information, clinical documentation, authorization information, and other required 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 whether patients meet applicable qualification and reimbursement requirements.
• Coordinate new patient admissions with Pharmacy, Nursing, Scheduling, Reimbursement, Billing, Authorization, and Clinical teams to prevent unnecessary delays in the start of care.
• Collaborate with hospital case managers, discharge planners, physician offices, healthcare providers, and referral sources to facilitate seamless transitions to home infusion services.
• Manage hospital referral portals, electronic referral systems, fax queues, and other referral channels to ensure incoming referrals are addressed promptly.
• Maintain effective communication with referral sources regarding referral status, missing documentation, authorization requirements, and admission coordination.
• Serve as a key liaison between Sales/Marketing, Intake, Authorization, Pharmacy, Nursing, Scheduling, Reimbursement, and Billing to improve communication and resolve operational barriers.
• Partner with Reimbursement and Billing teams to address insurance, authorization, eligibility, denial, and payment issues that may affect patient admission or reimbursement.
• Understand reimbursement methodologies and recognize the downstream financial impact of intake and authorization decisions on billing, collections, denials, and overall revenue cycle performance.
• Monitor referral volumes, turnaround times, pending referrals, authorization status, authorization turnaround times, expiring authorizations, conversion rates, department productivity, and other key performance indicators.
• Develop and maintain departmental metrics, dashboards, and quarterly performance reports for both Intake and Authorization.
• Analyze referral, authorization, and workflow trends to identify operational risks and opportunities for improvement.
• Prepare and present Intake and Authorization Department performance and operational reports to leadership.
• Identify workflow inefficiencies and implement process improvements that increase productivity, accuracy, quality, and speed to admission.
• Establish and maintain standardized Intake and Authorization procedures and ensure staff follow established workflows.
• Oversee relationships and workflows with outsourced intake, authorization, and reimbursement vendors, including adherence to company expectations and applicable Business Associate Agreement (BAA) requirements.
• Respond promptly and professionally to patient, referral source, physician office, payer, and internal customer service concerns.
• Escalate clinical, payer, operational, financial, or compliance concerns to the appropriate department or leadership when necessary.
• Ensure Intake and Authorization Department practices comply with HIPAA, CMS requirements, applicable state and federal regulations, accreditation standards, payer requirements, and company policies and procedures.
• Participate in departmental planning, strategic initiatives, quality improvement activities, and organizational performance improvement projects.
• Perform additional duties and responsibilities as assigned.

Qualifications

• High school diploma or equivalent required.
• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Nursing, or a related field preferred.
• Minimum 1 year of supervisory or management experience in a healthcare environment required.
• Home infusion, specialty pharmacy, home health, infusion intake, authorization, or related healthcare experience strongly preferred.
• 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 infusion therapies, specialty medications, medical necessity requirements, and payer qualification criteria preferred.
• Understanding of healthcare revenue cycle operations and the financial impact of intake and authorization decisions.
• Familiarity with infusion pharmacy software, electronic medical records, hospital referral portals, payer portals, and electronic referral systems preferred.
• Knowledge of HIPAA, CMS requirements, healthcare compliance, and accreditation standards such as ACHC.
• Strong leadership skills with demonstrated ability to coach, develop, and hold employees accountable.
• Excellent organizational and time-management skills with the ability to manage competing priorities and deadlines.
• Strong analytical, critical-thinking, problem-solving, and decision-making abilities.
• Excellent written and verbal communication skills.
• Exceptional interpersonal and customer service skills with the ability to work effectively with patients, referral sources, healthcare professionals, payers, employees, and leadership.
• Proficiency with Microsoft Office Suite and electronic healthcare documentation systems.

Preferred Skills

• 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.

Core Competencies

• Leadership and Accountability
• Team Development and Employee Coaching
• Referral and Intake Management
• Prior Authorization Management
• Payer and Insurance Knowledge
• Customer Service Excellence
• Communication
• Problem Solving and Critical Thinking
• Attention to Detail
• Organization and Prioritization
• Financial and Revenue Cycle Awareness
• Regulatory Compliance
• Cross‑Functional Collaboration
• Process Improvement
• Adaptability

About Oso Home Care

Oso Home Care, Inc. is a privately owned specialty home infusion company founded in 1984. We are committed to providing high-quality infusion services while maintaining a collaborative, supportive, and patient-focused work environment.

Oso Home Care is an Equal Opportunity Employer.