Registered Nurse Outcomes and Quality ReportingPhiladelphia, Pennsylvania

JOB SUMMARY:

The Outcomes Manager provides coordination of timely and accurate data collection and documentation to meet requirements of the mandated CMS LTCH Quality Reporting Program. To ensure accuracy in the coding and reflection of the patient’s care needs and in collaboration with the interdisciplinary team, this individual collects, reviews and monitors the patient information reported at admission and discharge for the CARE Data Set tool contained in the LTRAX database and reported monthly contained in the NHSN database as supported by documentation in the medical record. This position will assist in the ongoing monitoring of identified outcome benchmarks for the inpatient population. This position will assist in the mitigation of denials by auditing the EMR and other documentation systems for quality and technical compliance and providing guidance to the interdisciplinary team members on appropriate documentation. The Outcomes Manager has access to confidential patient information and maintains all confidentiality of all information.

ESSENTIAL FUNCTIONS:

Job Specific:

• Serves as the subject matter expert for all components of the CMS Quality Reporting Program as outlined in the most current CMS Long-Term Care Quality Reporting Program Manual.
• Stays current with how data interfaces between HD electronic systems.
• Responsible for initial and ongoing staff education regarding timeliness of clinical assessments and medical record documentation to meet the admission and discharge Assessment Reference Period guidelines.
• Ensures accurate and complete coding of the CARE Data Set record according to the CMS guidelines through Collaboration with the interdisciplinary team and review of the medical record documentation.
• Coordinates and collaborates with the primary CARE Data Set record Submitter to ensure timely transmittal of the CARE Data Set records to CMS national database.
• Acts as a backup Submitter for the transmission of CARE Data Set records into the CMS national database.
• Conducts CARE Data Set record data integrity audits through comparison of medical record documentation to the LTRAX documentation and makes appropriate corrections as needed.
• Conducts quarterly audits to ensure compliance with CMS quarterly deadlines.
• Monitors the LTRAX compliance and transmission reports.
• Monitors the CMS Long-term care Quality Reporting Program website for reporting announcements and FAQ updates.
• Reviews the quarterly Provider Preview Reports and does appropriate follow-up with CMS as needed.
• Reviews the CMS COMPARE site quarterly and provides leadership updates.
• Coordinates and collaborates with ICP department to ensure timely reporting of CMS Quality Program Requirements into the NHSN database.
• Assist Direct of Quality in managing quality and technical compliance of EMR and other documentation systems.
• Complete chart audits and monitoring of documentation outputs from EMR and other systems to ensure compliance with quality and technical components, as well as denial mitigation.
• Provide documentation guidance and direction to facility ICT team members re: documentation standards to ensure payor and medical necessity compliance.
• Assist Case Management department in identification of high risk areas requiring targeted education leading denials and assist with providing remedial education.
• Periodically performs medical record billing audits to ensure accuracy and consistency of documentation.
• Possesses leadership skills that help build and maintain a strong and collaborative team of individuals working toward the same goal; in particular effective communication skills, influencing through others, and conflict resolution skills.
• Demonstrates effective critical thinking skills
• Other duties as assigned.

QUALIFICATIONS:

• Graduation from an accredited Bachelors of Science in Nursing Preferred; current, unrestricted state licensure.
• 3 years data coordination, aggregation, analytics in LTCH hospital. Kindred Hospital Division regulatory compliance, quality experience or operational processes a plus.
• CPR/BCLS certification 
• 3+ years of experience in the care of patients in the long term acute hospital setting, preferred.
• Excellent oral and written communication and interpersonal skills.