The Director of Regulatory Affairs provides executive leadership for the organization's quality improvement, patient safety, regulatory compliance, accreditation, and enterprise risk management programs. This position is responsible for developing and maintaining a culture of continuous quality improvement while ensuring compliance with all applicable federal, state, and accreditation standards.
The Director oversees the Quality Improvement Department, Risk Management & Compliance, Medical Staff Office, and Utilization Review. Working collaboratively with executive leadership, physicians, clinical departments, and support services, this role develops strategic initiatives that improve patient outcomes, reduce organizational risk, and ensure regulatory readiness.
Classification: ExemptSchedule:- Monday - Friday
- 40 hour work week
Required Skills: 1. Ability to perform in-services, medical audits, analysis and appraisal of organizational structure and effectiveness.
2. Understanding of statistical principles related to analysis and reporting.
3. Experience with clinical data analysis required.
4. Must maintain current credentialing in field (i.e. RN or appropriate allied health license).
5. Proven experience with regulatory agencies. Must be trained as an ISO internal auditor with demonstrated ability to understand and interpret state and federal guidelines, including NIAHO standards and Medicare conditions of participation.
6. Must have strong interpersonal, written, verbal and presentation skills.
Minimum Work Experience: 1. A minimum of three (3) years risk management/compliance experience within a healthcare setting, preferred.
2. Understanding of Quality Improvement methodologies.
3. Understanding of medical staff bylaws and appointment process.
Minimum Education: 1. Registered Nurse or Allied Health Professional (BS required, Master's preferred).
2. Bachelor's degree in health care profession, business, organizational development or related filed is required.
Benefits & Work-Life
We not only offer comprehensive benefits and work-life programs to secure your future and balance your daily needs but also provide you stellar service for managing these programs through our Benefits Department.
Retirement - Securing your future
- Retirement - 457(b)
- Hospital Pension Plan - 401(a)
Health Benefits - Safe and Secure, Our Promise
- Health Insurance
- Dental and Vision Insurance
- Flexible Spending Account
- Life Insurance
- Supplemental Plans
- 340B Pharmacy Program
- Madisonhealth Services Discount
Work-Life Balance - Employee Assistance Program offers:
- Personal counseling (in-person and virtual)
- Life management services (child and senior care, moving, pets, home repair, disaster support, discounts, etc.)
- Senior care management
- Child care referral services
- Lifestyle coaching
- Health and wellness resources
- Legal & financial services
- Support tools for managers
- Onsite and virtual trainings
- Critical Incident Stress Management services when tragedy happens
