Clinical Outcomes Manager, FT - East Sandwich - PARTNERS HEALTHCARE SYSTEMS INC

The Inpatient Rehabilitation Facility Outcomes Manager (IRF OM) coordinates the timely and accurate data completion of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) for each rehabilitation inpatient and WeeFIM for pediatric patients. Assures timely data completion and submission to CMS and CMG generation. The IRF OM collects, reviews and monitors the information contained in the IRF-PAI, to ensure data accurately reflects acuity, diagnoses and care needs as documented within the medical record. The IRF OM collaborates with interdisciplinary, clinical documentation integrity, coding and medical staff to achieve accurate, timely IRF PAI completion and submission.

Provides regular operational and outcomes reports to leadership to assess hospital status compared with the region and nation; is the subject matter expert on IRF PAI CMS regulations (proposed and final rules, PPS, QRP, billing, completion). The Outcomes Manager maintains patient confidentiality.

• Completes Inpatient Rehabilitation Facility (IRF-PAI) data , enters and transmits to CMS within federally mandated timeframes and Spaulding policies for admissions and discharges (day 4 post admit and day 3 post discharge. Monitors and ensures correct LOA dates are recorded on the IRF PAI.
• Completes and transmits admission and discharge IRF PAI within required timeframes and with required percentage of completion (per CMS); updates concurrently if needed per CDI and Coding collaboration.
• Assures accurate Impairment Group Codes and co-morbidities in collaboration with coding and CDI staff to determine correct length of stay estimate and CMG in adherence with CMS IRF Coding standards. Communicates ELOS to clinical staff to assist with care/discharge planning.
• Participates in UDS and CMS training and assists with education, staff orientation and ongoing education to assure accurate IRF PAI data (GG, QRP, diagnoses, etc.); acts as liaisons between UDS and CMS help line.
• Participates in UDS and CMS training and communicates updates and changes to the IRF PAI Manual and CMS IRF PAI regulations (proposed and final rules, PPS, QRP, billing, completion) to eCare team and other staff as needed.
• Assists with coordination of clinical staff credentialing and competencies per Spaulding leadership.
• Collaborates with clinical educators and/or Quality Measure Documentation Coordinator on Quality Indicators (QI) scoring according to Uniform Data System (UDS) and CMS training and standards.
• Serves as a resource to licensed clinicians and clinical staff regarding questions and interpretation of QI scoring guidelines, according to UDS training guidelines, in order to assure the accuracy of the QI scores.
• Responds to CMS requests for documentation for IRF verification review for the 60% rule.
• Provides ongoing education to the staff of the hospital to assure accurate and timely completion of the IRF-PAI.
• Supports Spaulding requirements for UDSMR staff credentialing for QI scoring.
• Reviews medical record documentation to support the accuracy and timeliness of the IRF PAI scores including but not limited to functional scores and comorbid conditions, as dictated by CMS guidelines.
• Ensures that the IRF-PAI is consistent with the medical record documentation and reflects the functional status and care needs of the patient during the 3-day (72 hour) assessment period on admission and discharge.
• Collaborates with physicians and interdisciplinary team members to address documentation variances and assure clarifying documentation exist to close the variance gap where appropriate.
• Corrects the IRF-PAI in collaboration with the interdisciplinary team as warranted to assure accurate burden of care upon admission, throughout the stay and upon discharge.
• Periodically performs record review including IRF PAI, billing and medical record documentation to assure accuracy and consistency.
• Populate CMG and transmission date into Epic following submission to CMS.
• Reviews daily censusfor acute transfers, readmissions, discharge dispositions and identify interrupted stays per the CMS Training Manual. Feedback is given to clinical departments to address inconsistencies and omissions.
• Export IRF-PAI report monthly to MedTel Outcomes for follow-up evaluations.
• Demonstrates effective critical thinking, problem solving, time management, computer software and data management skills.
• Other duties as assigned - department, organization, or network activities are completed per established objectives.

Education/Degree

Required

• Graduate of accredited program of Nursing, Physical Therapy, Occupational Therapy, or Speech Language Pathology.

Preferred

• CRRN

Experience

Preferred

• Minimum of 5 years’ experience working in a post-acute healthcare setting. Ideally, experience in rehabilitation and/or IRF PAI, MDS, CARE tool management.
• Experience in health care data analysis
• Strong MS office skills (Word, Excel)
• Minimal knowledge and/or use ofMS Access, PowerPoint
• UDS experience
• Epic experience

Licensure

• Current Massachusetts RN, LPN, PT, OT, or SLP

Skills (Specific learned activity gained through training (e.g., computer skills, keyboarding, presentation, CPR, , etc.)

Required:

• Strong oral and written communication, interpersonal, critical thinking, problem solving, time management, computer software and data management skills
• Ability to critically analyze findings and identify trends. Ability to apply basic statistics. Exposure to research design and evaluation techniques.
• Effective verbal, electronic and written communications skills using the English language.
• Ability to read medical records and interpret the physician and other rehabilitation team members’ documentations.
• Computer proficiency required.

Spaulding Rehabilitation is an Affirmative Action Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.