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Regulatory Coordinator

Phoenix Children's Hospital
Phoenix, AZ Full Time
POSTED ON 2/6/2025
AVAILABLE BEFORE 5/4/2025

Position Details

Department : CORP | Accreditation and Regulatory

Location : Phoenix

Shift : Mon-Fri, Days, 8am-5pm

Category : Legal / Risk / Reg Compliance

Posting # : 904053

Employee Type : Full-Time

Position Summary

The Regulatory Coordinator is a leader with expertise in the accreditation and survey process. This role has enterprise wide responsibility related to maintaining a continuous level of preparation for all announced and unannounced surveys. This position utilizes process improvement principles to evaluate and address adherence to state licensing laws, CMS Conditions of Participation, DNV standards or other deeming agencies.

Position Duties

  • Expertise in accreditation process including but not limited to interpretation / assessment of standards and regulations, leading change, managing projects and issue resolution using collaboration and effective leadership skills.

Understands and has expertise in accreditation process, internal assessments, monitoring and process improvement activities and integrates risk issues into operational improvements.

Scope of work includes inpatient and outpatient areas.

  • Develops and manages a comprehensive system for assessing organizational compliance and risk based upon clinical quality data and outcomes, concurrent observation of practices, tracer findings, mock survey findings, and actual survey findings.
  • Provides at least quarterly updates on progress for organizational improvements aligns resources and communications this information to the appropriate administrative personnel.

  • Serves as primary subject matter expert for DNV, CMS, and State licensing law interpretation.
  • Leads all internal efforts to assess, improve and proactively prepare the organization for unannounced surveys with development of effective action plans to improve performance.

  • Independently facilitates accreditation related teams and PI teams integrating expertise with Performance Improvement Methodology
  • Proficient in change management and working effectively in multiple forums with multiple levels of staff. Uses subject matter experts externally as needed to ensure interpretation of regulations is accurate.

  • Develops and manages an effective organization wide communication system related to all relevant survey related information including but not limited to the survey process, survey process changes, and compliance results, new and changes standards.
  • Disseminates critical information and interpretation of standards and regulations enterprise wide. Prepares material pre, during the post survey to local area leaders, aligning accountability as appropriate.

  • Performs miscellaneous job related duties as requested.
  • Phoenix Children's Mission, Vision, & Values

    Mission

    To advance hope, healing and the best healthcare for children and their families

    Vision

    Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

    We realize this vision by :

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
  • Values

  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable
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