Job Opportunity Details

Job ID Specialty Geographic Location City State Recruiter
2296238 Other-Nurse Manager/Executive Boston MA KA Recruiting

Company Name: KA Recruiting
Recruiter Name: Alisha Dynan
Contact Phone: 617-746-2742

Job Title: Accreditation and Regulatory Nurse Manager Boston

In HouseID:
CO
Recruiter Email: alisha@ka-recruiting.com

Job Description

This is an Other-Nurse Manager/Executive Opportunity Only!

Please fill out the form below to contact a Coalition Partner about this job.

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(Only QUALIFIED Healthcare Professionals accepted) Other-Nurse Manager/Executive - Accreditation & Regulatory Manager Nurse
REF: CO221
Boston, MA
Under the direction of the Director of Patient Safety, Risk Management and Quality, and working collaboratively, the Accreditation & Regulatory Manager leads efforts to ensure continual organizational compliance and ongoing readiness with clinical quality and patient safety standards and regulations required by The Joint Commission, Massachusetts Department of Public Health and Center for Medicare and Medicaid Services. In this role the Accreditation & Regulatory Manager proactively plans, implements, coordinates and continually improves our efforts related to compliance, accreditation, and licensure requirements.

POSITION SUMMARY:
Accreditation & Regulatory Manager leads efforts to ensure continual organizational compliance and ongoing readiness with clinical quality and patient safety standards and regulations required by The Joint Commission, Massachusetts Department of Public Health and Center for Medicare and Medicaid Services. In this role the Accreditation & Regulatory Manager proactively plans, implements, coordinates and continually improves our efforts related to compliance, accreditation, and licensure requirements.

ESSENTIAL RESPONSIBILITIES | DUTIES:

Serves as the organizational expert for The Joint Commission, DPH and CMS standards, regulations and conditions of participation.

Responsible for the interpretation and communication of regulatory and licensing requirements throughout the organization.

Provides education and consultation to administrative and clinical leadership, staff and faculty throughout our facility regarding the requirements of accreditation and regulatory organizations, using both formal and informal venues, e.g. presentations, publications, email, computer-based methods.

Provides guidance and assistance to departments, sections, units and programs regarding improvements needed to ensure compliance with requirements of TJC, DPH and CMS.

Responsible for all aspects of the plan to ensure continual readiness with the clinical regulatory and accreditation requirements of the TJC, DPH and CMS. This includes but is not limited to:
Organizational, department, section, unit and program assessments and identification of risk
Plan and scheduling readiness mock surveys
All ongoing communication with regulatory agencies regarding survey and readiness activities
Completion of annual TJC application
Periodic Performance Review completion and submission

Responsible for communication of the continuous readiness plan to leadership and key groups throughout our facility.

Responsible for ensuring preparation of reports assessing institutional, department, section, program and unit compliance with accreditation and regulatory requirements.

Ensure that administrative and clinical leadership are continuously aware of our readiness for TJC, DPH and CMS surveys, including description of specific issues that are in need of improvement.

Works closely with Patient Safety|Risk Management, Quality Improvement and Clinical Analytics including coordination of the Joint Commission Performance Improvement and NPSG standards compliance.

Leads a coordinated response to unannounced external accrediting or regulatory agency visits such as DPH, Joint Commission or CMS.

Co-chairs TJC Steering Committee with Director Quality and Patient Safety.

Responsible for overseeing our policy and procedure system including co-chair of the Policy and Procedure Roundtable.

JOB REQUIREMENTS

EDUCATION:

Baccalaureate Degree in nursing required.

Master's Degree (or equivalent) is also required. Healthcare focus highly desirable.

For more information and to apply please send your resume to chelsey@ka-recruiting.com or apply here directly!




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