Accreditation and Regulatory Compliance Specialist

Regions Hospital is seeking an Accreditation and Regulatory Compliance Specialist to support and advance a culture of continuous regulatory readiness and accreditation excellence. This position is responsible for leading the planning, implementation, and ongoing sustainment of accreditation and regulatory compliance initiatives that reduce organizational risk, strengthen patient and staff safety, and ensure compliance with applicable regulations, statutes, and accreditation standards. Working in partnership with the Manager of Accreditation and Regulatory Compliance, the specialist serves as a key resource to leaders, departments, and multidisciplinary teams across the organization.

Under the direction of the manager, the specialist will lead and participate in onsite and virtual accreditation surveys, regulatory investigations, and external agency reviews. This role collaborates closely with operational and clinical leaders to identify compliance risks, conduct assessments, develop corrective action plans, and implement sustainable improvement strategies. The specialist also coordinates activities that promote continuous readiness, regulatory awareness, and organizational compliance while supporting a culture of high reliability and excellence in patient care.

This position reports to the Manager of Accreditation and Regulatory Compliance and partners closely with accreditation and compliance leaders across both Regions Hospital and Methodist Hospital. While approximately 75% of the role's work will support Regions Hospital, the position will also collaborate with Methodist's Regulatory Compliance Program Manager to advance accreditation excellence, regulatory readiness, and organizational compliance across both organizations.

• Bachelor’s degree and at least three (3) years of healthcare-related project management experience, or an equivalent combination of education and experience.
• Two (2) years of experience in accreditation, regulatory compliance, quality, risk management, patient safety, clinical operations, or a related healthcare function. Candidates with experience in ambulatory or outpatient healthcare settings are encouraged to apply.
• Working knowledge of accreditation and regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), Minnesota Department of Health (MDH), and other applicable regulatory agencies.
• Familiarity with Occupational Safety and Health Administration (OSHA) regulations, building codes, and fire and life safety standards.
• Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
• Strong written, verbal, and interpersonal communication skills, with the ability to effectively communicate across all levels of an organization.
• Demonstrated critical thinking, analytical, problem-solving, and decision-making skills.
• Ability to manage multiple priorities, adapt to changing demands, and meet competing deadlines in a fast-paced environment.
• Strong organizational and project coordination skills, including the ability to schedule and manage complex meetings, calendars, and work plans.
• Ability to work both independently and collaboratively as part of a team.
• Demonstrated ability to build and maintain positive working relationships with frontline staff, leaders, physicians, and other stakeholders.
• Experience collecting, analyzing, interpreting, and presenting data through reports, presentations, and other communication tools.
• Knowledge of evidence-based practices related to patient safety, regulatory compliance, and healthcare quality improvement.
• Ability to conduct risk assessments, identify improvement opportunities, and support corrective action planning.
• Exceptional attention to detail and the ability to maintain accurate records and documentation.
• Ability to manage sensitive and confidential information with professionalism and discretion.

• Masters Degree
• Certified Professional in Healthcare Quality (CPHQ) credential

• M-F; core business hours
• This hybrid position requires onsite work three days per week, typically Tuesday through Thursday,with additional onsite presence asneeded to support business and operational needs.

• $43.42 - $65.14 hourly
  • Compensation is based on the level and requirements of the role. Pay within our ranges may also be determined by education, experience, knowledge, skills, location, and abilities as well as internal equity. Hired…