DME Decision Support Manager

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:

• Bachelor's Degree in business or related field or equivalent years of relevant experience is required
• Master's Degree in related field is preferred
• Minimum of five (5) years of clinical business experience is required
• Minimum of two (2) years of Analytics and/or business intelligence required

Competencies, Knowledge and Skills:

• Excellent proficiency with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc.
• Demonstrates excellent analysis and reporting skills
• Strong data visualization and analytical skills
• Excellent decision making/problem solving skills
• Exceptional interpersonal and relationship building skills
• Excellent critical listening and thinking skills
• Proven ability to effectively interact with all levels of the organization of management within and externally to the organization
• Excellent written and verbal communication skills
• Customer service oriented
• Ability to shape the approach to needed results and gain consensus of the approach
• Proven ability to prioritize work and team assignments to deliver projects on time, on budget, and meeting stakeholders' expectations
• Demonstrates a sense of urgency
• Knowledge of Utilization Management (UM) and, Case/Care Management (CM) healthcare is required.
• Strong experience in the healthcare payer industry and knowledge of Medicaid and Medicare
• Comprehensive understanding of clinical indications, applications, regulation and reimbursement of DME equipment and related services

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:
$92,300.00 - $161,600.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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