Regulatory Compliance Program ManagerInspired by faith. Driven by innovation. Powered by humankindness.
CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings.As our Regulatory Compliance Program Manager, you will help ensures that all facets of patient safety are identified and integrated into comprehensive plans so that Virginia Mason Franciscan Health (VMFH) can provide the highest standards of patient care.Every day you will facilitate on-going regulatory compliance activities through extensive rounding on clinical and non-clinical departments at VMFH.Key Responsibilities Include:Compliance Leadership: Ensure assigned hospitals and clinics are continuously aligned with The Joint Commission (TJC) standards and all applicable state and federal regulations.Continuous Readiness Facilitation: Drive ongoing regulatory compliance activities through extensive rounding and engagement with both clinical and non-clinical departments across VMFH facilities.Policy & Procedure Implementation: Oversee the effective implementation of policies and procedures to ensure regulatory adherence.Survey Preparedness & Management: Lead and coordinate all aspects of survey preparation, manage survey processes, and ensure diligent follow-up on findings.Vulnerability Assessment & Reporting: Proactively assess standards compliance, identify potential vulnerabilities, and report findings to key stakeholders with clear actionable insights.Training & Education: Develop and conduct targeted training programs for management, educators, and staff in response to identified or potential deficiencies, fostering a culture of compliance.To be successful in this role you must have regulatory expertise, patient safety acumen and strong analytical / problem solving skills.Job RequirementsRequiredBachelor's degree in healthcare administration, nursing or other healthcare-related field.Five years of progressively responsible related work experience that would demonstrate attainment of the requisite job knowledge.Minimum of three (3) years of progressive management responsibility in an acute care setting, one (1) of which is related to managing an organization's or department Quality, Safety, or Regulatory Program.Minimum of two (2) years of clinical, patient experience or equivalent.Experience developing, and implementing clinical, service and operation process initiatives, both small and large scale.Any equivalent combination of education and experience which meets requirements and provides the required knowledge, skills and abilities to perform the essential functions of the position.PreferredActive Washington State Registered Nurse LicenseCertified Professional in Healthcare Quality (CPHQ)