Full time
Day Shift
Position Purpose
Develops implements and maintains a comprehensive, organization-wide, ongoing regulatory and compliance readiness program. This position is responsible for assisting the Director of Quality, Patient Safety and Regulatory affairs with the coordination and oversight of regulations and standards governing the hospitals set forth by all Regulatory Agencies, evaluation activities and the survey process. This position also supports the work of the organization to build high reliability through a safety program. The position also supports quality and outcome measures to meet organizational goals. The responsibilities include acting as a resource for staff by providing education and assistance regarding regulatory compliance, patient safety and quality and associated activities. Coordinates or participates in all regulatory related meetings, and participates in preparatory regulation compliance meetings of various departments and programs. Coordinates or participates in patient safety committees and quality and outcome groups and requested by the Director.
What you will do
Support and facilitate hospital-wide ongoing compliance with regulatory standards including TJC surveys
Serve as a contact with The Joint Commission and DPH
Assist in maintenance of the plan for unannounced surveys
Identify resources needed for standard compliance and ongoing readiness
Provide assistance to the organizational program to sustain safety training and habits throughout the organization
Assist the organization to use data to plan, deliver and evaluate patient safety in care and services
Minimum Qualifications
Bachelor’s Degree in healthcare, or related field required
At least 5 years current experience in a quality/regulatory and/or patient safety related role preferred
RN preferred
Professional in Healthcare Quality (CPHQ)
Knowledge of regulatory requirements, patient safety initiatives and quality indicators as related to the hospital setting and the ability to relay pertinent information to staff.
Position Highlights and Benefits
Full time 40hrs M-F days
Excellent benefits - starting day 1!
Ministry/Facility Information
Saint Francis Hospital is committed to exceeding the expectations of our patients and families by providing world-class service in a progressive, people-centered, compassionate health care environment. We are licensed for 617 beds and 65 bassinets, are a major teaching hospital and the largest Catholic hospital in New England.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Trinity Health is one of the largest not-for-profit, Catholic health care systems in the nation. It is a family of 123,000 colleagues and nearly 27,000 physicians and clinicians caring for diverse communities across 26 states. Nationally recognized for care and experience, the Trinity Health system includes 88 hospitals, 135 continuing care locations, the second largest PACE program in the country, 136 urgent care locations and many other health and well-being services. Based in Livonia, Michigan, its annual operating revenue is $21.5 billion with $1.4 billion returned to its communities in the form of charity care and other community benefit programs.
