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Registered Nursing
CMS Quality Payment Program
Full Time
8 Hour Shift
Rancho Mirage, CA 92270
Job #
  • Job Objective: A brief overview of the position.
    • The RN-Quality Program Coordinator & Government Liaison at Eisenhower Health is responsible for maintaining a thorough understanding of the Quality Reporting Programs, including the Merit-Based Incentive Payment System (MIPS), which is one track of the Quality Payment Program (QPP), established through the Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) and the CMS Inpatient Quality Reporting, Outpatient Quality Reporting, Promoting Interoperability, CA state reporting, and The Joint Commission ORYX reporting. This position will work closely with leadership, clinicians and with internal regulatory/compliance staff to help determine which quality measures and/or objectives to report, how the data will be reported, and how data will be tracked throughout the performance period to ensure regulatory requirements are met.
  • Reports to
    • Director-Quality Patient Safety Officer
  • Supervises
    • N/A
  • Ages of Patients
    • Neonate/ Infant
    • Pediatric
    • Adolescent
    • Adult
    • Geriatric
  • Blood Borne Pathogens
    • Low Potential
  • Qualifications
    • Education
      • Required: BSN
      • Preferred: MSN
    • Licensure/Certification
      • California RN License
    • Experience
      • At least three to five years of experience in a health system setting required
      • Electronic health record (EHR) data extraction and functionality, minimum 5 years
      • Experience working with CMS regulations and contractors
      • Project management experience minimum 1 year
      • Performance Improvement and Quality Management, 3-5 years
      • Data management and analysis, 3-5 years
  • Essential Responsibilities
    • Provide oversight of quality reporting programs, such as through a qualified registry, to promote compliance under MIPS
    • Collaborate with eligible clinicians to determine which quality measures to report to meet minimum requirements (and additional measures, as eligible clinicians desire) in order to potentially receive a positive payment adjustment
    • Review final quality-specific and overall composite performance scores from the Centers for Medicare & Medicaid Services and assist with any appeal processes, when necessary
    • Create and update policies and procedures concerning the quality performance category of MIPS and other Quality Reporting Programs
    • Serve as a change agent offering guidance, partnership and coordination support to areas in the organization that require information and education related to QPP and other Quality Reporting Programs.
    • Gather and analyze clinical and financial data that assists with driving practice transformation, quality program compliance and improve patient care
    • Serve as liason between population health platform, EHR and clinicians
    • Conduct data analysis on impact of legislative and regulatory proposals (quality measure standards and program requirements) and analyze trends
    • Facilitate process change for accurate and reportable data entry including ongoing monitoring of adherence
    • Monitor deadlines and deliverables to assure the organization meets program deadlines as well as reporting progress to leadership
    • Develop clinical recommendations to address program metrics
    • Demonstrate efficient management of reporting projects, data manipulation and analysis
    • Educate eligible clinicians about quality reporting expectations, the importance of quality reporting, and its impact on reimbursement
    • Track quality data throughout the reporting period to identify and communicate with eligible clinicians about areas for improvement
    • Implement processes for quality data reporting
    • Evaluate the efficiency and effectiveness of data submission processes and resolve any identified issues
    • Create and execute strategies for improvement opportunities to ensure high performance and help secure optimal reimbursement
    • Maintain collaborative relationships with providers and departmental staff to engage staff and resolve issues in a timely manner
    • Identify and manage organization’s response to regulatory or policy updates related to MIPS quality and other Quality Reporting Program reporting
    • Determine whether electronic health record technology must be upgraded to meet certified EHR technology (CEHRT) requirements for bonus-point eligibility within quality component of MIPS
    • Use business intelligence tools to create data extracts and reports and conduct basic statistical analysis
    • Performs other duties as assigned