RN, Regulatory Compliance Quality Specialist
Job Location:
Philadelphia, PA - USA
Monthly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
Job Details
The Quality Specialist ensures the accuracy and regulatory compliance of Jefferson Healths clinical quality data submitted toCMS The Joint Commission and other agencies. This role oversees data abstraction validation and reporting across multiple
regulatory programs while managing key databases and vendor partners. The specialist provides actionable insights to
leadership supports audit readiness and helps drive systemwide quality improvement by maintaining reliable transparent
performance data.
Job Description
Registered Nurse Preferred
The Quality Specialist ensures the accuracy and regulatory compliance of Jefferson Healths clinical quality data submitted to CMS The Joint Commission and other agencies. This role oversees data abstraction validation and reporting across multiple regulatory programs while managing key databases and vendor partners. The specialist provides actionable insights to leadership supports audit readiness and helps drive systemwide quality improvement by maintaining reliable transparent performance data.
- Manage CMS regulatory programs (HIPQRP HOPQRP IPFQR Star Rating).
- Oversee data abstraction and ensure required sampling volumes are met (including GWTG).
- Manage critical databases (GWTG TJC-ORYX eCQM QNet HQR PEPPER portal).
- Perform data validation and quality control (QCd).
- Generate and analyze reports using Medisolv and HQR.
- Ensure timely and accurate regulatory submissions.
- Support CMS validation (IP OP & IPFQR) audits and prepare required documentation.
- Manage abstraction vendors (HIA Medisolv) review invoice for accuracy and monitor performance.
- Prepare executive summaries and communicate results to leadership.
- Serve as subject matter expert (SME) on CMS and TJC requirements.
- Upload data to regulatory agencies (TJC & CMS).
- Participate in multidisciplinary committees and provide data insights.
- Bachelors Degree Healthcare related field of study
- Registered Nurse Preferred
- Masters Degree Healthcare related field
- 5 years in healthcare quality or regulatory reporting
- Knowledge of CMS and Joint Commission standards
- Strong analytical and critical thinking skills
- Attention to detail and accuracy
- Effective communication and collaboration skills
- CPHQ - Certified Professional in Healthcare Quality - National Association for Healthcare Quality within 2 Years
Work Shift
Workday Day (United States of America)Worker Sub Type
RegularEmployee Entity
Albert Einstein Medical CenterPrimary Location Address
5501 Old York Road Philadelphia Pennsylvania United States of AmericaNationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.
For more benefits information please click here
Required Experience:
IC
About Company
At Thomas Jefferson University in Philadelphia, PA, we are helping you to redefine what’s possible with innovative and tailored education opportunities.
