Job Summary:
The DME Decision Support Manager is responsible for leading in-depth analyses and data solutions to support Clinical leadership in financial, operational, and quality improvement decisions related to durable medical equipment (DME).
Essential Functions:
Support the development, management, and growth of DME programs
Assist with the continuous improvement of program best practices, processes, and tools
Responsible for monitoring and tracking program performance
Support new business activities including developing responses to Request for Proposals (RFPs) and new business implementation activities as needed
Facilitate and drive Program Stakeholder meetings
Provide regular reporting and maintain ongoing communications to senior management, stakeholders, and executive sponsors
Track, compile, and report program metrics
Develop and produce detailed reports, business decision documents, meeting minutes, and notification for assigned programs
Provide input on requests for complex wheelchairs, custom prosthetics and other high-cost DME to ensure they are aligned with best practices thereby improving patient outcomes and reducing unnecessary expenditures
Collaborate with clinical teams to gather necessary information and documentation to support decision-making
Stay informed of industry trends, market rates, and reimbursement policies, providing analysis and insights on pricing structures for various DME products to ensure competitive and fair pricing
Maintain ownership of pricing guardrails for custom/specialized DME - driving intelligence into single-case agreement negotiation and contract execution
Conduct market intelligence on fair-market pricing and standard reimbursement methodology - presenting recommendations to regional and national contracting divisions for contract remediation
Provide strategic input to support contracting teams in negotiations with DME providers
Identify and evaluate DME providers to formulate, implement and track network initiatives and steer care to providers with high-quality and high affordability that ensure optimal patient outcomes and cost-effectiveness
Conduct analysis of the DME provider network - resulting in recommendations for network consolidation / optimization that are presented to regional and national contracting divisions for implementation
Collaborate with Health Partners/Provider Relations in maintaining relationships with key DME providers to foster cooperation and improve service delivery
Coordinate between contracting teams and clinical teams to evaluate unique provider contracting and partnership opportunities that align with clinical needs and organizational goals, supporting affordability and enhancing member care
Work with cross-functional teams to identify opportunities and implement strategies for process improvement, technology and innovation within the DMEPOS program, enhancing efficiency and patient satisfaction
Maintain awareness of current trends in the DMEPOS market, including advancements in technology, new products and shifts in consumer demand
Analyze utilization data trends, costs and outcomes associated with DMEPOS to inform decision-making and identify areas for intervention, ultimately leading to better resource allocation and patient care
Prepare reports and presentations for management and stakeholders to communicate findings and recommendations, ensuring transparency and facilitating informed decision-making.
Provide training and support to staff regarding DME policies, procedures and best practices, enhancing staff knowledge and adherence to DME policies and best practices and improving overall department efficiency
Serve as a resource for clinical teams and other departments to streamline DME-related inquiries and support clinical teams in delivering high-quality care
Perform any other job duties as requested
Education and Experience:
Bachelo
C
CareSource Management Services LLC