Coordinates the data collection on the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), ensures the presence of supporting documentation, and provides staff education to ensure compliance with CMS guidelines. Coordinates all efforts for immediate issue resolution concerning FIM scoring. Conducts ongoing review of IRF-PAI related data and ensures that therapy and nursing complete the IRF-PAI within required time frames. In conjunction with department management, maintains and updates policies and procedures that govern the development, use and implementation of the IRF-PAI. Essential Functions
Coordinates all areas of Functional Independence Measure (FIM) score capture and supportive documentation for the completion of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI).
Sets prescribed IRF-PAI completion dates for the interdisciplinary team.
Ensures that appropriate health professionals are involved in the assessment and that members of the assessment team are aware of the importance of completeness and accuracy in their assessment functions.
May assist the Admissions Liaison with pre-certifications and re-certifications, as needed.
Reviews medical records to assure that clinical documentation supports FIM scores. Confers with the clinical team members regarding the scoring of FIM items to assist in resolution of any inconsistencies.
Reviews medical records and confers with medical staff members to assure that co-morbidities are properly identified and documented in the medical record.
Develops and interprets policies and procedures and acts as the primary resource for immediate problem solving in regards to Medicare’s IRF prospective payment system (FIM scoring, impairment group coding, tiering distribution), coverage and classification criteria, and quality report program requirements (QRP).
Assumes the task of reviewing each IRF-PAI form completely, accurately and timely.
Provides initial and ongoing FIM and PPS education including new-employee orientation and focused education as needed.
Tracks FIM training completion and FIM competency of clinicians.
Provides technical assistance to staff regarding developing quality improvement indicators/monitors, measurement methodology and charting techniques.
Assists department managers in preparing departmental UR, PI and PE reports.
Facilitates with CARF prep, and all licensing body requirements of accreditation including state, federal, DNV and Hoag hospital compliance.
Ensure that each Medicare and Medicare Advantage client has consented to the collection of IRF PAI data.
May perform data validation studies, work with teams to evaluate resource utilization issues and perform other duties as assigned. Collaborates with Medical Director and the Interdisciplinary team on quality and outcome measures and results.
Reviews and audits the medical record for compliance with required documentation as directed.
Education, Training and Experience
Required: BSN or MSN; Master’s degree in PT, OT, or SLP, LCSW. Minimum of 2 years prior experience in rehabilitation or closely related field.
Preferred: Experience and certification in FIM and IRF-PAI, quality indicators, Medicare compliance, and documentation requirements. Ability to educate others.
Skills or Other Qualifications
Required: Critical thinking, ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions. Ability to communicate effectively on the patient’s behalf.
Works well 1:1 and in a team to obtain better outcomes.
Possesses a knowledge of the business of healthcare along the continuum of care, clinical decision support data analysis/synthesis, and quality improvement, regulatory and legislative issues.
Self-directed individual with ability to prioritize multiple tasks and meet deadlines, excellent attention to detail, and maintain a high level of work quality.
Proven ability to interface with all customer levels (physicians, organizational staff, insurance companies, patients and family members). Decisive and capable of exercising good judgment under pressure.
Preferred: Qualified bilingual or multilingual candidates. Working knowledge of Microsoft Office Suite, including Outlook, Word, Excel, and PowerPoint, plus healthcare database systems.
Nurse educator and familiarity with ICD 10 coding.
License and Certifications
Required: Current license as Registered Nurse (BSN), Occupational Therapy (OT), Physical Therapy (PT) or Speech Language Pathology (SLP) with State of California licensure.
Hoag Memorial Hospital Presbyterian has been the community’s beloved hospital and destination for state-of-the-art sub-specialty medicine. This combination of world-class clinical excellence and close-knit neighborhood care has long distinguished us. When you join Hoag, you become a member of our family. We believe being a member of the Hoag family requires you to give and Hoag is committed to those who work with us to provide patient care.