Registered Nurse, Ambulatory Care Manager – Population Health
Bon Secours Mercy Health
DME Decision Support Manager
CareSource
full-time
Posted on:
Location Type: Hybrid
Location: Ohio • 🇺🇸 United States
Visit company websiteSalary
💰 $92,300 - $161,600 per year
Job Level
Mid-LevelSenior
About the role
- 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).
- 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 notifications 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
Requirements
- 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
- Excellent proficiency with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc.
- 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
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
- Bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data analysisbusiness intelligenceutilization managementcase managementprogram managementreportingmarket analysiscontract negotiationprocess improvementDME reimbursement
Soft skills
leadershipcommunicationcollaborationstrategic thinkingproblem-solvingorganizational skillsstakeholder managementtrainingfacilitationadaptability
