DME Decision Support Manager

DME Decision Support Manager

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 include supporting the development, management, and growth of DME programs, assisting with the continuous improvement of program best practices, processes, and tools, and monitoring and tracking program performance. The role also involves facilitating and driving program stakeholder meetings, providing regular reporting and maintaining ongoing communications to senior management, stakeholders, and executive sponsors, and tracking, compiling, and reporting program metrics. Additionally, the DME Decision Support Manager develops and produces detailed reports, business decision documents, meeting minutes, and notifications for assigned programs. They provide input on requests for complex wheelchairs, custom prosthetics, and other high-cost DME to ensure alignment with best practices, thereby improving patient outcomes and reducing unnecessary expenditures. The role requires collaboration with clinical teams to gather necessary information and documentation to support decision-making, staying informed of industry trends, market rates, and reimbursement policies, and providing analysis and insights on pricing structures for various DME products to ensure competitive and fair pricing. The DME Decision Support Manager maintains ownership of pricing guardrails for custom / specialized DME, driving intelligence into single-case agreement negotiation and contract execution, and conducts market intelligence on fair-market pricing and standard reimbursement methodology, presenting recommendations to regional and national contracting divisions for contract remediation. They also 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. The role involves analyzing the DME provider network, resulting in recommendations for network consolidation / optimization that are presented to regional and national contracting divisions for implementation. Additionally, the DME Decision Support Manager collaborates with Health Partners / Provider Relations in maintaining relationships with key DME providers to foster cooperation and improve service delivery, coordinates between contracting teams and clinical teams to evaluate unique provider contracting and partnership opportunities, and works 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. The role also requires maintaining awareness of current trends in the DMEPOS market, analyzing 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. The DME Decision Support Manager prepares reports and presentations for management and stakeholders to communicate findings and recommendations, ensuring transparency and facilitating informed decision-making. They 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. The role also serves as a resource for clinical teams and other departments to streamline DME-related inquiries and support clinical teams in delivering high-quality care.