Intake Manager in Fishersville, Virginia at Valley Vital Care LLC

Intake Manager

Department: Operations
Reports To: Director of Operations / Intake Director
FLSA Status: Exempt
Location: Remote or Hybrid

Position Summary

The Intake Manager is responsible for leading Valley Vital Care's intake operations and overseeing the referral-to-start-of-care process for biologic, acute, home infusion, and specialty therapies. This role serves as the operational owner of the patient onboarding experience, ensuring referrals are processed accurately, efficiently, and in compliance with payer and regulatory requirements. The Intake Manager leads a team of Intake Specialists, drives referral conversion, resolves reimbursement and authorization barriers, and partners cross-functionally to ensure patients receive timely access to prescribed therapies. The ideal candidate brings a blend of operational leadership, clinical knowledge, payer expertise, and patient access experience within home infusion, specialty pharmacy, or related healthcare settings.

Essential Duties and Responsibilities

Intake Operations Leadership

• Oversee daily intake operations and ensure timely, accurate processing of all incoming referrals.
• Manage referral workflows from referral receipt through registration, insurance verification, authorization, financial clearance, and therapy initiation.
• Establish, monitor, and optimize workflows to ensure referrals are processed within established service-level expectations.
• Monitor referral volume, conversion rates, intake productivity, and referral-to-start-of-care metrics.
• Ensure all referrals are reviewed for completeness, accuracy, clinical appropriateness, and required documentation.
• Proactively identify and remove operational barriers that delay therapy starts.
• Develop and maintain departmental KPIs, dashboards, and reporting to drive operational performance and accountability.
• Ensure exceptional service levels for patients, providers, referral sources, and internal stakeholders.

Team Leadership & Development

• Recruit, hire, onboard, train, coach, and develop Intake Specialists and other intake team members.
• Conduct regular staff meetings, performance reviews, and individual coaching sessions.
• Monitor team workloads and allocate resources appropriately based on referral volume and business demands.
• Foster a culture of accountability, service excellence, collaboration, continuous improvement, and patient-centered care.
• Serve as the primary escalation point for complex intake, referral, authorization, reimbursement, and patient access concerns.
• Establish team goals and monitor performance against organizational objectives.

Authorization, Reimbursement & Payer Strategy

• Ensure staff maintain expertise in commercial insurance, Medicare, Medicaid, managed care, and payer-specific authorization requirements.
• Maintain advanced knowledge of medical and pharmacy benefit structures and reimbursement pathways.
• Assist with complex prior authorizations for specialty medications, biologics, and infusion therapies.
• Review clinical documentation, physician orders, and medical records to maximize authorization success rates.
• Support denial management activities, including appeals, reconsiderations, and peer-to-peer review coordination.
• Identify reimbursement barriers and collaborate with internal stakeholders to develop effective resolution strategies.
• Work closely with billing and reimbursement teams to minimize financial barriers and optimize patient access to care.
• Ensure adherence to payer requirements and evolving coverage policies.

Cross-Functional Collaboration

• Partner with Pharmacy, Nursing, Revenue Cycle, Reimbursement, Clinical Liaison, and Business Development teams to facilitate timely patient admissions.
• Collaborate with providers, prescribers, clinics, hospitals, and payer representatives to obtain required documentation and approvals.
• Develop and maintain strong referral source relationships while delivering exceptional customer service.
• Communicate referral status updates, authorization delays, and therapy start timelines to key stakeholders.
• Support strategic initiatives designed to improve operational performance and patient outcomes.

Quality Improvement & Compliance

• Lead intake quality initiatives and establish best practices across all referral lines.
• Identify workflow inefficiencies and implement process improvement initiatives.
• Develop and monitor performance metrics that support operational excellence.
• Ensure compliance with company policies, accreditation standards, and applicable regulatory requirements.
• Support audit readiness and continuous quality improvement efforts.
• Promote a culture of compliance, accountability, and operational excellence.

Required Qualifications

• Bachelor's degree preferred; equivalent healthcare experience may be considered.
• Minimum of 3-5 years of experience in home infusion, specialty pharmacy, healthcare intake, patient access, reimbursement, referral management, or related healthcare operations.
• Minimum of 2 years of clinical healthcare experience required, including experience as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Pharmacy Technician, Medical Assistant, Respiratory Therapist, Patient Care Coordinator, or other direct patient care, clinical support, or healthcare operations role.
• Previous leadership or management experience overseeing intake, patient access, reimbursement, referral management, or authorization teams.
• Strong understanding of referral intake, insurance verification, prior authorizations, reimbursement processes, and patient access operations.
• Knowledge of commercial insurance, Medicare, Medicaid, and managed care payer requirements.
• Strong understanding of clinical documentation, medical necessity requirements, physician orders, and treatment plans.
• Ability to evaluate clinical information and partner with providers, pharmacists, nurses, and payers to facilitate therapy approval and patient access.
• Demonstrated knowledge of HIPAA regulations, healthcare privacy standards, and regulatory compliance requirements.
• Excellent organizational, communication, problem-solving, and leadership skills.
• Ability to prioritize multiple responsibilities and drive results in a fast-paced environment.

Preferred Qualifications

• RN, BSN, PharmD, RPh, CPhT, or other licensed clinical background strongly preferred.
• Prior experience working for a health plan, insurance carrier, pharmacy benefit manager (PBM), managed care organization, utilization management department, or payer organization is highly preferred.
• Demonstrated understanding of payer authorization processes, coverage determination criteria, utilization management, and reimbursement policies from both provider and payer perspectives.
• Experience managing home infusion and specialty medication prior authorizations.
• Experience with authorization denials, appeals, peer-to-peer reviews, and reimbursement optimization.
• Familiarity with EMR/EHR systems, pharmacy software platforms, intake management systems, and revenue cycle workflows.
• Experience supporting accreditation and regulatory standards within home infusion, specialty pharmacy, infusion services, or healthcare operations environments.

Success Profile

The ideal Intake Manager will:

• Lead a high-performing intake team that consistently delivers exceptional service and referral conversion results.
• Effectively navigate complex authorization and reimbursement requirements.
• Leverage clinical knowledge to support documentation review, patient access strategies, and operational decision-making.
• Drive operational efficiency while maintaining exceptional quality and compliance standards.
• Build strong relationships with providers, payers, referral sources, and internal stakeholders.
• Ensure patients receive timely access to prescribed therapies through effective leadership, payer expertise, and continuous process improvement.
• Foster a culture of accountability, engagement, and service excellence.

Working Conditions & Legal Requirements

• This position may require extended periods of sitting, computer use, phone communication, and management of multiple electronic systems simultaneously.
• The employee must be able to effectively communicate with patients, healthcare providers, referral sources, payers, and internal team members in a professional and timely manner.
• Valley Vital Care reserves the right to modify, interpret, or apply this job description as business needs require. This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position.
• Employees may be required to perform duties outside of those specifically outlined herein to support business operations and organizational objectives.
• The Intake Manager is expected to comply with all applicable federal, state, and local laws, regulations, accreditation standards, and company policies, including but not limited to HIPAA, Medicare and Medicaid regulations, payer requirements, fraud, waste and abuse prevention standards, and company compliance programs.
• The successful candidate must maintain any required professional licenses, certifications, registrations, or credentials in good standing throughout employment.
• Employment is contingent upon successful completion of all pre-employment requirements, including background screening, credential verification, employment verification, and drug screening, where permitted by law.
• The Intake Manager is responsible for protecting confidential patient, employee, and company information and adhering to all privacy and security requirements.
• Failure to comply with company policies, performance expectations, or applicable legal and regulatory requirements may result in corrective action, up to and including termination of employment.

Equal Employment Opportunity Statement

Valley Vital Care is an Equal Opportunity Employer and is committed to fostering a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by federal, state, or local law.

At-Will Employment Disclaimer

Nothing in this job description is intended to create an employment contract or alter the at-will nature of employment. Employment with Valley Vital Care is at-will, meaning either the employee or the Company may terminate the employment relationship at any time, with or without notice and with or without cause, subject to applicable law.

This position is ideal for a healthcare operations leader who combines clinical insight, payer expertise, and operational excellence to ensure patients receive timely access to life-changing therapies while developing and leading a high-performing intake team.

• 5+ years intake or referral with team leadership
• Accountable for referral to start and quality metrics
• Demonstrated people leadership and performance management
• Owns escalated referrals and referral source relationships
• Meets the executive exemption duties test