Director, Post Acute Assessments

Brigham and Women’s Hospital • Remote (MA, United States) • $200k - $250k / year • 1m ago

Job Description - Director, Post Acute Assessments (3303240)

Job Summary

The CMS Assessment Director is responsible for overseeing the accurate and timely completion of the post-acute prospective payment and mandatory CMS assessment instruments:

Inpatient Rehabilitation Facility (IRF) - IRF Patient Assessment Instrument (IRF-PAI)
Skilled Nursing Facility (SNF)- Minimum Data Set (MDS)
Long Term Care Hospital (LTCH), Continuity Assessment Record and Evaluation (CARE tool)

The CMS Assessment Director supports, trains, and collaborates with the IRF PAI, MDS, and CARE tool staff and the Interdisciplinary Care Team to assure regulatory compliance and assessment integrity. Under the direction of the Chief Compliance Officer, facilitates improvement in the overall quality, completeness, and accuracy of CMS assessments to drive accurate quality reporting program information and revenue integrity. Collaborates with the Interdisciplinary Care Team to be successful in this role. Applies clinical and assessment coding knowledge while collaborating with physicians, nurses, other patient caregivers, and compliance, coding, clinical documentation integrity staff—Educates members of the patient care team on documentation guidelines and assessment regulatory requirements on an ongoing basis.

Key Responsibilities

Manage CMS assessment operations, competencies, and regulatory compliance.
Hire, train, support, and guide IRF PAI, MDS, and CARE tool staff to ensure timely completion and transmission of CMS assessments.
Coordinate annual review of and response to proposed and final CMS rules.
Ensure a systematized workflow to ensure assessments are completed per required timeframes (admission, discharge, leave of absence) prescribed by CMS regulations.
Collaborate with assessment and clinical staff to ensure timely patient assessment data collection for quality measure calculation and payment determination.
Applies diplomacy and professionalism when interacting with physicians and clinical staff, especially when addressing missing or conflicting medical record information.
Stay abreast of IRF-PAI, MDS, and Care Tool Manual content and facilitate communication of and amend workflows related to changes.
Monitor compliance with data collection and submission deadlines for the IRF, SNF, and LTCH Quality Reporting Program (QRP).
Monitor, manage, and/or develop work queues to assist in the completion and timely submission of data collection.
Implement internal controls to assure accuracy; gather, format, and report data to Compliance Officer monthly.
Participate in quality improvement initiatives related to IRF PAI, MDS, and CARE tool data.
Coordinates coverage with the assessment team to ensure timely completion of assessments.
Responsible for gathering, analyzing, and trending statistical data; shares with leadership and clinical teams to celebrate successes and find opportunities for improvement.
Reviews external (i.e., PEPPER) and internal data (i.e., outliers) to trend, track and educate to improve outcomes.
Assists with preparing and presenting clinical documentation monitoring/trending reports for review with physicians and hospital leadership.
Is a liaison between the Assessment/Outcomes team and eCcare support.
Manages relationships with CMS assessment IS vendors (UDS, LTRAX).
Exhibits resourceful, up-to-date working knowledge of post-acute coding guidelines (Federal and State, etc...), researching websites, publications, reference materials, and educational opportunities. Collaborates with the Coding Manager to understand and adhere to coding policies and guidelines published in the “Coding Clinic” and coding department policies and procedures.
Keeps current with CMS assessment regulatory changes, proposed and otherwise, through conferences, reference material, and review of current literature.
Maintains confidentiality of all customer/hospital information.
Demonstrates flexibility in changing work environment, adjusting work schedule accordingly.
Upholds the Organizational Values of Innovation, Collaboration, Accountability, Respect, and Excellence.
Other duties as assigned.

Qualifications and Experience

Graduate of an accredited School of Nursing, CRRN Preferred.
Current licensure from the Massachusetts Board of Registration to practice professional nursing.
Experience as an MDS, IRF PAI, or CARE tool coordinator, certification preferred (AAAPACN, AANAC, UDS, EREHAB).
Minimum of 5 years experience in either clinical nursing or case management.
Knowledge of post-acute regulatory/accreditation requirements.
Basic knowledge of coding/classification systems appropriate for inpatient CMG, PDPM, and DRG prospective payment systems.
Computer proficiency required. Microsoft Office applications preferred with the ability to learn new software. Excel for data management/interpretation. Epic experience desirable.
High level of service delivery. Demonstrate initiative with the ability to prioritize work, meet deadlines, and adapt to changing situations.
Work independently, be self-directed, and contribute as a leading member of a team.
Ability to present information in writing and presentation form.
Maintain variable work schedule to meet department needs (evenings, holidays, weekends, and travel).

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, to perform essential job functions, and to receive other benefits and privileges of employment.