Director of Patient Outcomes

ClearSky Health•Cleveland, WI

3d•Onsite

About The Position

The Director of Patient Outcomes directs completion of the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and provides clinical support for PPS and functional outcome measure (FOM) instruments to ensure accurate functional-status scoring and reflection of each patient’s care needs. The role may direct the Case Management Department as needed and integrates company values into daily practice. The Director may lead and direct case management staffing, caseloads, education, direction, and mentorship. The role reports on and assists with management of patient outcomes; supports utilization reviews and medical-necessity denials; collects data and monitors Quality Indicators and Care Tools; maintains FOM credentialing, staff education, and FOM functions; and helps ensure accuracy through rounds, education, and certification. The Director reviews physician documentation for medical necessity and functional changes, tracks Compliancy (CMS13), and assists in obtaining required documentation from clinical liaisons and physicians. The position also attends Operations/Admissions meetings, reviews patients for tiers and compliance, attends team conferences, and assists Health Information Management with coded-tier accuracy and queries.

Requirements

Clinical licensure is required; PT, OT, SLP, or RN is preferred. Other licensure or certification may be considered based on appropriate qualifications.
Must maintain an acceptable driving record, a current driver’s license, and insurability.

Nice To Haves

Two years of recent experience in an acute care setting is preferred.
PT, OT, SLP, or RN licensure is preferred.

Responsibilities

Direct completion of the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS).
Provide clinical support for PPS and functional outcome measure instruments to ensure accurate scoring of functional status and reflection of patient care needs.
Lead and direct the Case Management Department as assigned, including staffing needs, caseloads, and education, direction, and mentorship of the Case Management Team.
Report on and assist in the management of patient outcomes.
Attend utilization reviews and provide reports as necessary, including managing medical-necessity denials.
Collect data and monitor Quality Indicators and Care Tools.
Maintain FOM credentialing, staff education, and FOM functions, ensuring accuracy through rounds, education, certification, and related activities.
Review physician documentation for medical necessity and functional changes.
Track Compliancy (CMS13) and assist in obtaining required documentation from clinical liaisons and physicians.
Attend Operations/Admissions meetings and review patients for tiers and compliance.
Attend team conferences and assist Health Information Management with accuracy of coded tiers and queries.
Integrate company values into daily practice.