Healthcare Accreditation & Compliance Lead

UC Health; Cincinnati (OH); On-site; USD 65,000 - 95,000; Full time

Job summary

UC Health is looking for an Accreditation Coordinator to lead accreditation and regulatory activities across hospital departments, ensuring CMS, The Joint Commission, and state standards are met. The role involves education, data management, and collaboration with clinical and administrative teams to maintain readiness.

Responsibilities include mock surveys, gap analysis, and developing dashboards and reports to support leadership and regulatory compliance efforts.

Qualifications

• Bachelor's degree in nursing or healthcare field.
• Master's degree preferred.
• Professional certification preferred (HACP, CPPS, CPHQ).
• 3–5 years equivalent experience preferred.
• Working knowledge of The Joint Commission, CMS Conditions of Participation, and state regulations.
• Strong analytical, organizational, and project management skills; excellent written and verbal communication."
• Ability to work independently and collaboratively in a fast-paced environment.

Responsibilities

• Lead preparation for internal and external accreditation and regulatory surveys.
• Partner with inpatient and outpatient operators to conduct mock surveys, audits and tracers.
• Monitor and interpret regulatory updates and translate them into action plans and tools.
• Collaborate with clinical and operational leaders to close identified compliance gaps.
• Develop dashboards, reports, and scorecards for leadership and operational teams.
• Track findings, action plans, and progress toward compliance goals.

Skills

Joint Commission knowledge

CMS Regulations

State regulations

Analytical skills

Project management

Communication skills

Education

Bachelor's degree in Nursing

Master's degree preferred

Professional certification preferred (HACP/CPPS/CPHQ)

Tools

AMP (Accreditation Manager Plus)

Job description

UC Health is looking for an Accreditation Coordinator to lead accreditation and regulatory activities across hospital departments, ensuring CMS, The Joint Commission, and state standards are met. The role involves education, data management, and collaboration with clinical and administrative teams to maintain readiness.

Responsibilities include mock surveys, gap analysis, and developing dashboards and reports to support leadership and regulatory compliance efforts.