Program Lead- Regulatory and Accreditation

Are you passionate about healthcare quality, regulatory excellence, and supporting safe, compliant patient care environments? This role offers the opportunity to work closely with the Executive Director of Accreditation to help ensure ongoing compliance with federal, state, and accreditation requirements across hospital locations.

The position plays a key role in survey readiness, regulatory coordination, and serving as a trusted departmental resource for compliance standards and best practices. Candidates with prior clinical experience encouraged to apply.

Day Shift

Who We Are

Accreditation, Licensure and Regulatory Affairs in maintaining high quality and safe care by ensuring organizational systems and processes comply with the state and federal regulations and other identified standards ex. Joint Commission.

Participate and support activities relating to accreditation and regulatory standards for all Hospital sites including preparation for, compliance with, and follow up for all surveys.

About the Role

Responsible for leading the project activities of assigned program. Coordinates status reports as well as participating on teams and working with project staff and stakeholders to assure that requirements are incorporated within the project design. Assigns work to team members to assure timely completion of project milestones and deliverables as appropriate. Develops policies and procedures as appropriate.

Identifies and escalate issues following departmental guidelines.

What You'll Bring

Minimum Education

Bachelor's Degree (Required) Or

Minimum Work Experience

3 years Relevant work experience (Required)

1-year Relevant work experience with master's degree (Preferred

Functional Accountabilities

Program Liaison

• Lead the program by being the primary point person.
• Serve as the liaison between CNHS and external stakeholders as needed
• Manage program specific partnerships with various stakeholders including leadership at affiliated institutions.
• Communicate barriers, challenges and any other issues that affect progress.

Budget and Financial Management

• May be responsible for appropriate use of funds and resources.
• Prepare documentation and projections to support new programs and the budget planning process.
• Monitor monthly performance reports and budget variances and resolve discrepancies as needed.

Safety

• Speak up when team members appear to exhibit unsafe behavior or performance
• Continuously validate and verify information needed for decision making or documentation
• Stop in the face of uncertainty and takes time to resolve the situation
• Demonstrate accurate, clear and timely verbal and written communication
• Actively promote safety for patients, families, visitors and co-workers
• Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Benefits That Support You

• Comprehensive health coverage, including medical, prescription, infertility, and transgender health services.
• Generous paid time off, including vacation accrual from day one, sick leave, holidays, and a personal day.
• Financial wellness support, including a 401(k) plan and healthcare and dependent care spending accounts.
• Employer-paid life, AD&D, and long-term disability coverage, with optional supplemental plans.
• Additional perks, including tuition assistance, fitness resources, employee assistance, commuter benefits, and more

Why Join Us

• Nationally Recognized Excellence – Consistently ranked among the Top 10 Children’s Hospitals in the nation by U.S. News & World Report.
• Leading Pediatric Care – One of the largest and most comprehensive children’s hospitals in the country, offering nationally ranked specialties and cutting-edge treatments.
• Innovation & Research – A premier academic medical center with a strong commitment to pediatric research, education, and advancing the future of child health.
• Mission-Driven Culture – Dedicated to providing family-centered care while fostering a collaborative, supportive environment for clinical teams