Brown University Health · 1 day ago
Manager of Accreditation and Regulatory Readiness
Providence, RI
Full-time
Onsite
Mid, Senior Level
$105K/yr - $173K/yr
3+ years expBrown University Health is seeking a Manager of Accreditation and Regulatory Readiness to oversee accreditation and regulatory compliance. This role involves managing compliance with standards from various accrediting bodies and ensuring continuous readiness for external surveys, while providing consultation and support to leadership and stakeholders.
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Responsibilities
Consistently applies and serves as a role model for the Brown University Health shared 'CARE' values of •Compassion, Accountability, Respect and Excellence•
Is responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct
Provides support and leadership for Brown University Health’s Quality Priorities service and treatment settings
Develops and manages approach to a proactive, systematic, objective, and continuous process of self-assessment of Brown University Health compliance and readiness with all TJC, CMS, DOH and related regulatory and accreditation standards in partnership with key stakeholders across the system
Develops a process that includes ongoing mock survey audits and tracers for compliance with TJC and CMS standards
Leads and coordinates the interpretation of results and development of action plans across all affiliates to address areas needing improvement
Guides Brown University Health affiliates to meet external and regulatory standards of TJC, CMS and the RI Department of Health
Develops and implements strategies to ensure continuous readiness for external unannounced surveys or reviews
Advises senior management and executive leadership at each affiliate and at the system level of potential vulnerabilities and recommends improvement or corrective actions to maintain compliance
Develops and implements a robust communication system that effectively informs all involved stakeholders about accreditation requirements, implications, and changes
Disseminates information clarifying regulatory and accreditation standards and organizes departmental and interdepartmental survey preparation and responses
Develops and manage a proactive, systematic, and continuous process for improving readiness and compliance with all standards and requirements for the Brown University Health using a project management approach
Leads efforts for ongoing accreditation assessment and survey preparation-related activities
Assists leadership in identifying, developing, and maintaining needed accreditation-required policies and procedures
Collaborates with key stakeholders to ensure accreditation-related training and education requirements for Brown University Health staff are met or exceeded
Maintain current working knowledge of all relevant regulatory and accreditation standards
Performs other duties as assigned
Qualification
Required
A bachelor's degree in health administration, nursing or healthcare professional field
Must possess a relevant professional certification (e.g., CPHQ or equivalent)
Experience with leading, managing and supporting organizational accreditation (e.g., Joint Commission, CMS)
Working knowledge of all Microsoft Office software applications
A minimum of three years of related work experience
Excellent communication skills including the ability to communicate information effectively to others both verbally and in writing
Ability to make various presentations internally and externally
Preferred
Advanced degree in related field
Experience with the principles and practices of healthcare quality management
Company
Brown University Health
Brown University Health provides an integrated academic health system offering hospital services, outpatient care and clinical education.
10001+ employees
Funding
Current Stage
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