Compliance Specialist

Site: The General Hospital Corporation

Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Summary: Responsible for supporting the implementation and maintenance of the hospitals compliance program including conducting audits providing training monitoring compliance activities and assisting with investigations to promote a culture of ethical conduct and mitigate compliance risks within the organization. Does this position require Patient Care No
Essential Functions:
-Assist in developing implementing and maintaining the hospitals compliance program including policies procedures and protocols.
-Conduct periodic audits of hospital departments and processes to assess compliance with policies and identify areas for improvement.
-Assist departments in understanding and implementing compliance policies ensuring consistency and adherence throughout the organization.
-Support the reporting and investigation of compliance-related incidents and potential violations.
-Assist in monitoring compliance activities analyzing data and preparing compliance reports for presentation to senior management and relevant committees.
-Participate in compliance committee meetings providing updates on compliance activities and contributing to discussions on compliance matters.

Education: Bachelors Degree Related Field of Study required

Can this role accept experience in lieu of a degree No

Licenses and Credentials

Experience: Experience in compliance legal or a related field. 2-3 years required

Knowledge Skills and Abilities:
- Knowledge of relevant laws and regulations applicable to the industry or sector (e.g. financial healthcare technology).
- Familiarity with compliance frameworks and best practices.
- Excellent attention to detail and analytical skills.
- Strong written and verbal communication skills.
- Ability to work collaboratively and independently as needed.
- Proficiency in using Microsoft Office and other relevant software applications.

Reportingto theClinical Compliance Manager Central Sterile Processing & Supply(CSPS) and receiving direction from the Director of Operational Alignment & High Reliability the Compliance Specialistwill be responsible fortheindependentacquisition analysis interpretation and reporting of data to supportof theCSPS Department andHigh-Level Disinfection and Sterilization Program(HLDS)and its subcommitteesto achieve established goals and program incumbentwill interact with business leaders at all levels throughout the organizationincludingPhysicians Finance Sterile Processing Nursing Administrative Directors and Managers and PHS resourcesto execute initiatives.S/he must be able to work independently and collaboratively tolocateand validate dataidentifydata requirements and communicate data specifications to team members and leaders. The Project Specialist will also manage the resources associatedtothese role is expectedto work collaboratively withthe Sterile Processing Department and willintermittentlysupport projects involvingProcedural Services andMGBinitiatives.

High-Level Disinfection& SterilizationProgram

1. Act asacritical participantin the evolution and continueddevelopmentand implementation of theHigh-Level Disinfection and Sterilization Program.

2. Participates in the hospital-wide Interdisciplinary Tracer Program to learn define andevaluatereprocessing practices in all active reprocessing areas; developa deep familiarity with AAMI standardsover time.

3. Maintain documentation systems as processes evolve and become more standardized; assignsdepartment representatives for ongoing Tracer participation.

4. Implementsunified weekly and monthly reportsdescribingthe programs progress toleadership andappropriate governancecommittees.

5. Attendsthe High-Level Disinfection and Sterilization Task Force meetingsand associated subcommittees developing presentations writing minutes and coordinating follow-up on action items resulting from the meetings.

6. Closely adheres toproject planschartersand clinical support resources to ensureobjectivesare met.

7. Ensures assessmentsare catalogedfor all active reprocessing locations.
8. Develops and implementscomprehensive unit-specific remediation plans that may include the following elementsemployee training workflow development inventory assessment and conversion and design/construction. Remediation plans aim to reduce the breadth of reprocessing locations and process variability to ensure sustainable best practices are in place.

9. Practices sound risk management throughout the project process.

10. Gathers and compiles documentation of metrics and data sources routineadhoc reporting tofacilitatereplication.

Sterile ProcessingMGBand Procedural Service Committee

1. Completes cross-institutional project initiatives and informs leadership of best practices that may be adopted from other hospital departments orprocedural areas.

2. SupportstheMGBand Procedural Services Committee to support thestrategic alignment ofthedepartment hospital and systems-basedsterile processing functions andworkstreams.

3. Leads the implementation of the information system SPDR to manage track and bill for reprocessing activities performed by SPD on behalf of the PO.

4. Provide training to other data analysts working within the Sterile Processing team.

5. Develop a deep familiarity with EPIC and SPM instrument tracking software to appreciate underused capabilities for structuring improvements in departmental workflows;leveragesdata visualization tools to build operational dashboards.

6. Developand introducenew and unique ways to improve data deliveryoperationsand to create new opportunities.

7. Develop reporting/analyticsolutions butalso be able to assess/determine business impact draw meaningful conclusions and make recommendations for actions.

Physical Requirements

• Standing Occasionally (3-33%)
• Walking Occasionally (3-33%)
• Sitting Constantly (67-100%)
• Lifting Occasionally (3-33%) 20lbs - 35lbs
• Carrying Occasionally (3-33%) 20lbs - 35lbs
• Pushing Rarely (Less than 2%)
• Pulling Rarely (Less than 2%)
• Climbing Rarely (Less than 2%)
• Balancing Occasionally (3-33%)
• Stooping Occasionally (3-33%)
• Kneeling Rarely (Less than 2%)
• Crouching Rarely (Less than 2%)
• Crawling Rarely (Less than 2%)
• Reaching Occasionally (3-33%)
• Gross Manipulation (Handling) Constantly (67-100%)
• Fine Manipulation (Fingering) Frequently (34-66%)
• Feeling Constantly (67-100%)
• Foot Use Rarely (Less than 2%)
• Vision - Far Constantly (67-100%)
• Vision - Near Constantly (67-100%)
• Talking Constantly (67-100%)
• Hearing Constantly (67-100%)

Onsite

55 Fruit Street

40

Regular

Day (United States of America)

Pay Range

$63648.00 - $90750.40/Annual

Grade

6

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

1200 The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework