Accreditation, Regulatory, and Licensing Specialist V

Kaiser Permanente; Riverside (CA); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Kaiser Permanente is seeking a senior regulatory compliance professional to conduct regulatory audits and facilitate on-site surveys. The role requires coordinating with multiple departments to ensure readiness, develop action plans, and manage data for reporting to accrediting bodies.

The position emphasizes expert consultation on regulations, policy interpretation, and driving corrective actions to maintain licensing and accreditation across facilities and services.

Qualifications

• Bachelor's degree required with 7+ years in health care operations, quality, risk management, or related field
• Master's degree preferred; 3+ years leadership experience
• Experience with NCQA or Joint Commission surveys is a plus

Responsibilities

• Conducts regulatory audits and surveys to assess compliance readiness.
• Facilitates on-site visits and evaluations with cross-functional teams.
• Develops data management processes for complex practitioner/provider data.
• Creates action plans and monitors corrective actions for compliance.
• Collaborates with departments to ensure state, federal, and accrediting standards are met.

Skills

Regulatory compliance

Project management

Data analysis

Stakeholder communication

Leadership

Risk assessment

Cross-functional collaboration

Policy interpretation

Education

Bachelor's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field

Master's degree (preferred) in related field

Tools

Credentialing Databases

Job description

Job Summary:

Conducts regulatory audits and surveys by consulting on the interpretation and interaction of current regulatory policies and requirements in preparation for surveys. Organizes, coordinates, and conducts facilitation of on-site visits and evaluations. Performs site visits in accordance with criteria to ensure survey readiness. Ensures completion of surveys, independently. Conducts routine audits and mock surveys to aid in preparedness, tracking, trending, and facilitation of corrective action plans. Collaborates with others to complete annual reporting. Ensures licensing and accreditation by reviewing requirements for new, expanding, and existing facilities/services in relation to relevant accrediting standards, evaluating relevant risk and impact independently. Consults with departments to ensure certification and conducts complex gap analyses. Serves as the subject matter expert by maintaining and facilitating awareness of internal policies and consulting on the interpretation and interaction of current policies, and how they interact with the current climate, and potential changes to regulations and legislation. Develops complex content and delivers education programs to align policies with regulatory requirements. Conducts data management by entering and analyzing complex practitioner/provider data. Independently reviews, drafts, and provides consultative expertise on implementation of action plans for timely implementation.

Essential Responsibilities:

• Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross-functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members. Practices self-leadership; creates and executes plans to capitalize on strengths and improve opportunity areas; influences team members within assigned team or unit. Adapts to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Models team collaboration within and across teams.
• Conducts or oversees business-specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Develops work plans to meet business priorities and deadlines; coordinates and delegates resources to accomplish organizational goals. Recognizes and capitalizes on improvement opportunities; evaluates recommendations made; influences the completion of project tasks by others.
• Serves as the subject matter expert for regulations projects/committees, and internal stakeholders by: providing consultation on the interpretation and interaction of current policies, and how they interact with the current climate, and potential changes to regulations and legislation; serving as a technical advisor on committees and projects to drive development of policies or procedures for regulations and auditing processes; developing complex content and delivering tailored educational programs to align organizational policies and procedures with regulatory requirements; and anticipating and weighing practical/technical considerations in addressing issues and coordinating with the appropriate stakeholders to develop resolutions.
• Develops data management and reporting processes by: entering complex practitioner/provider data and conducts data cleaning as needed; and entering, analyzing, and independently drafting and reviewing action plans/recommendations required data into appropriate databases.
• Ensures licensing and accreditation by: independently reviewing and guiding others to review requirements for new, existing, and expanding facilities/services to aid in achievement of compliance with state, federal, and accrediting standards; consulting with other departments to ensure certification for complex cases; and independently conducting a widely impactful and detailed gap analysis and mentoring others to identify services renewals and planning to ensure services are compliant.
• Identifies and recommends improvements to processes of responding to regulatory audits and survey preparedness efforts by: independently enacting complex reporting, keeping current on regulatory requirements, and guiding others to do the same in preparation for surveys (e.g., NCQA, Joint Commission, AAAHC); serving as liaison between external evaluators, vendors, and senior stakeholders to facilitate on-site visits and evaluations; independently conducting, reviewing, evaluating upon site visit criteria, and performing site visits as appropriate to ensure survey readiness; delivering requested complex audit documentation, information, and reports; assessing the workflow of auditing surveys to identify gaps in completion and reporting, focusing on high vulnerability areas; facilitating educational forums, conducting routine audits, and leading mock surveys within departments to ensure auditing and survey preparedness tracking, trending, and facilitating the development of high impact corrective action plans (CAP) as necessary in collaboration with applicable departments to assure site visit compliance; and leading the collaborations with other departments (e.g., Revenue Cycle), gathering documents and data to support the timely completion of the annual state/federal/regulatory body reporting as required.

Knowledge, Skills and Abilities: (Core)

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

• Consulting
• Credentialing Database Systems
• Delegation
• Evidence-Based Medicine Principles
• Health Care Data Analytics
• Health Care Policy
• Health Care Quality Standards
• Managing Diverse Relationships
• Project Management
• Quality Assurance Process
• Risk Assessment

Minimum Qualifications:

• Minimum three (3) years of experience in a leadership role with or without direct reports.
• Minimum three (3) years of experience with databases and spreadsheets.
• Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND minimum seven (7) years of experience in health care operations, quality, risk management, hospital environment, or a directly related field OR minimum ten (10) years of experience in health care operations, quality, risk management, hospital environment, or a directly related field.

Preferred Qualifications:

• Three (3) years of National Committee of Quality Assurance (NCQA) or related survey experience.
• Master's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field.