Regional Durable Medical Equipment Manager
Primary Location Downey, California
Worker Location Flexible
Job Number 1353856 Date posted 05/08/2025
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Description:
Coordinates with physicians, staff, vendors and DME staff regarding utilization of DME. Manages the performance of a team DME Clerks insuring quality, timeliness and accuracy of work. Responsible for the utilization review of the NONC letters as per the appropriate regulatory guidelines to include but not limited to DMHC, NCQA, Medicare and MediCal. Some weekend and holiday work required.
Job Summary:
Coordinates with physicians, staff, vendors and DME staff regarding utilization of DME. Manages the performance of a team DME Clerks insuring quality, timeliness and accuracy of work. Responsible for the utilization review of the NONC letters as per the appropriate regulatory guidelines to include but not limited to DMHC, NCQA, Medicare and MediCal. Some weekend and holiday work required.
Essential Responsibilities:
- Plans, develops, assesses, and evaluates ongoing DME services provided to members. Accountable for the performance of a team of 6-15 DME Clerks.
- This includes oversight and tracking of utilization of ordered item/equipment to ensure quality, timeliness and accuracy of orders placed.
- Evaluates the individual performance of their team members including written annual performance appraisals.
- In conjunction with manager assists with the adjustment of the workflow for their teams of DME clerks.
- Reviews and authorizes the referrals for DME/P&O from KP Physicians for KP members personal and home usage.
- Accurate interpretation of member specific benefits for each request as it applies to the item(s) requested; able to articulate to member the various nuances of their coverage type to include but not limited to KPSA, member cost share, self-funded programs, managed MediCal, HDHP, Traditional etc.
- Prioritizes workflow in order to insure timely clinical review of requests, and timely completion of NONC letters within regulated time frames.
- Medical record review as necessary to ascertain additional information necessary for completion of referral for ordering or for UM review for denial.
- Confers with Regional Consultants over any clinical issues in which a question or problem arises.
- Maintains working knowledge of all coverage criteria and DME Formulary Guidelines.
- Responsible for the utilization management/reauthorization and tracking of equipment for example: oxygen, wound vacs, wheelchairs, breast pumps, Dyna splints, and/or any other regional review initiative.
- And/or any other regional review initiative.
- Promotes/improves member client services by problem solving of member, clinician and provider complaints and or grievances.
- Must have demonstrated history of excellent service skills exhibited by courtesy, cooperative spirit and tact when interacting with patients, families and staff.
- Consistently supports compliance and the Principles of Responsibility (KPs code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures.
- In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives.
- Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.
Basic Qualifications:
Experience
- Minimum two (2) years' experience in hospital and/or clinical operations.
- Minimum three (3) years' experience in a management/supervisory role within a health plan or integrated health care delivery system.
Education
- Bachelor's degree in nursing or health related field, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Knowledge of Nurse Practice Act, JCAHO, and other federal/state/local regulations.
- Computer skills and experience with performance improvement projects and planning, coordinating and implementing programs required.
- Ability to communicate verbally and in writing clearly and accurately.
- Must be able to work independently.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Minimum two (2) years' experience in utilization management, discharge planning, or transfer coordination.
- Current and valid License in a clinical discipline (such as RN, LVN, PT, RT, Prosthetics).
Notes:
- This is a temporary position.
Primary Location: California,Downey,Downey Boeing - Independence Park
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Temporary
Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee
Job Level: Manager with Direct Reports
Department: Regional Offices - Pasadena - DME Administration - 0801
Pay Range: $114500 - $148170 / year
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: Yes, 50 % of the Time
Flexible: Work location is on-site at a KP location, with the flexibility to work from home.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.
Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.
Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.
Submit Interest
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
