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SSM HealthSH

Regulatory Specialist Senior

SSM Health is a large, Catholic, not-for-profit health system committed to providing comprehensive and compassionate care across the Midwest.

SSM Health

Employee count: 1001-5000

United States only

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WI-REMOTE

Worker Type:

Regular

Job Highlights:

This is an exciting, newly created full-time Regulatory Specialist Senior role supporting post-acute services. The position works primarily remote, with periodic travel to home health and hospice locations in Missouri, Illinois, Wisconsin, and Oklahoma, based on regulatory and accreditation timing.

The ideal candidate brings senior-level regulatory experience, preferably with Joint Commission accreditation in home health and hospice, though candidates with Joint Commission experience in hospital or long-term care settings will also be considered. This role requires a high degree of autonomy and comfort helping establish and grow regulatory oversight.

Please note that we can only hire individuals who are residents of the states of WI, OK, IL, and MO.

Schedule

The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m.

Job Summary:

Coordinates regulatory compliance activities. Works collaboratively with leaders, clinicians and other staff in the development and implementation of regulatory requirements to identify and reduce risks, and meet regulatory requirements. Ensures implementation of an integrated regulatory compliance and accreditation program.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

  • Possesses a working knowledge of all The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) Conditions of Participation and State Hospital Licensing Act standards and regulations and stay current with changes to these standards and regulations. Reviews current standards and ensures awareness of new and revised standards. Possesses a working knowledge of organizational policies and procedures and assist with development and revision of Policies and Procedures to ensure compliance with hospital regulations.
  • Maintain a state of continual readiness related to The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS) Conditions of Participations (CoPs) and State specific regulations. This role supports the hospital (s) using the SSM Regulatory Model, Scope of Service, approach and tools to ensure a stated of constant readiness for survey and compliance laws and regulations.
  • Provides education, and consultation and interpretation of regulations and accreditation standards, with an emphasis on hospital, ambulatory, behavioral health, standards and/or regulations.
  • Assists in facilitating Facilitates an integrated organizational approach to assessing and meeting regulatory requirements and process improvements. Supports and Facilitates coordination of regulatory surveys for the outpatient and inpatient practice.
  • Supports and facilitates coordination of regulatory surveys for the outpatient and inpatient practice. Organizes and leads surveys, also provides ongoing support for survey activity and/or other compliance needs. Utilizes team leading and facilitation skills to support meetings, action plans, development of measures and goals, and data collection. Coordinates all hospital related regulatory inquiries. Facilitate all state, CMS, and TJC on-site visits and remote complaints/investigations. Responsible for developing and monitoring action plans to address compliance issues. Ensures all required regulatory related reports to regulatory agencies and within the hospital and region are completed and submitted accurately and timely.
  • Plans and implements systems for assessment and improvement of processes related to hospital operations to ensure regulatory compliance. Coordinates and facilitates hospital wide and clinic tracers. Gathers data from tracers and chart audits to create departmental scorecards related to key compliance issues. Responsible to communicate findings to Administrative Teams. Facilitates the completion of the annual Intracycle Monitoring (ICM), a complete gap analysis of compliance with TJC standards. Works with leaders to develop, implement and monitor action plan for any identified non-compliance.
  • Conducts investigations and audits to identify areas of risk, draft a plan for improving compliance practices to address those risks, and monitors to ensure the program is following best practices and standards.
  • Serves and Lead in the absence of the Regional Manager.
  • Performs other duties as assigned.

EDUCATION

  • Bachelor's degree

EXPERIENCE

  • Three years' experience

PHYSICAL REQUIREMENTS

  • Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
  • Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
  • Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
  • Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
  • Frequent keyboard use/data entry.
  • Occasional bending, stooping, kneeling, squatting, twisting and gripping.
  • Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
  • Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS

  • None

Department:

8060000114 Clinical Excellence

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

  • Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).

  • Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

  • Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.

Explore All Benefits

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.

About the job

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Posted on

Job type

Full Time

Experience level

Education

Bachelor degree

Experience

3 years minimum

Location requirements

Hiring timezones

United States +/- 0 hours

About SSM Health

Learn more about SSM Health and their company culture.

View company profile

SSM Health is a Catholic, not-for-profit, fully integrated health system dedicated to advancing innovative, sustainable, and compassionate care for patients and communities throughout the Midwest and beyond. With roots tracing back to 1872, SSM Health serves a broad geographic region, including Illinois, Missouri, Oklahoma, and Wisconsin, making it one of the largest health systems in the nation.

Our organization employs over 40,000 team members and has more than 13,900 providers committed to fulfilling our mission: 'Through our exceptional health care services, we reveal the healing presence of God.' This mission informs every aspect of our operations, guiding us in the delivery of quality care while striving to meet the diverse needs of the communities we serve. In 2023 alone, SSM Health provided $470 million in community benefits, including over $346 million in uncompensated care, reflecting our dedication to community health initiatives.

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