Accreditation and Regulatory Specialist

3 weeks ago


Annapolis, United States Luminis Health Full time

Accreditation and Regulatory Specialist | Luminis Health


Embark on a rewarding journey with Luminis Health. Enjoy competitive benefits, growth opportunities, and a vibrant work culture that nurtures innovation and collaboration


Position Objective:

  • Serve as the expert resource on regulatory/accreditation and licensure standards.
  • Design and implement a systematic approach for compliance awareness.
  • Guide the development of hospital policies aligning with regulatory guidelines.
  • Assist in interpreting standards and regulations across Luminis Health facilities.


Essential Job Duties:

  • Provide expertise and guidance on accreditation and licensure standards.
  • Identify vulnerabilities and aid in developing corrective action plans.
  • Ensure timely dissemination of regulatory information and updates.
  • Maintain relationships with external agencies and facilitate documentation compliance.
  • Coordinate onsite surveys and readiness activities for regulatory and accreditation assessments.


Educational/Experience Requirements:

  • Bachelor's degree in Nursing or healthcare-related field.
  • Minimum three years of experience in accreditation and regulatory compliance or Quality Management.
  • Knowledge of federal and state regulations and Joint Commission standards.
  • Proficiency in continuous quality improvement methodologies.
  • Strong interpersonal skills and computer literacy.


Required License/Certifications:

  • Current RN licensure preferred.
  • CPHQ certification preferred.
  • Lean Six Sigma Green Belt preferred.


About Luminis Health:

Luminis Health, a newly integrated health system formed in 2019, serves residents of Anne Arundel County, Prince George’s County, Calvert County, and Maryland’s Eastern Shore. Comprised of Anne Arundel Medical Center (AAMC), Doctors Community Medical Center (DCMC), J. Kent McNew Family Medical Center, and Luminis Health Clinical Enterprise (LHCE), the health system includes 635 licensed beds, more than 6,400 employees, 1,800 medical staff and 1,300 volunteers. The new health system includes more entry points for coordinated care across the region, improved access to care close to home, enhanced quality and improved health outcomes. LHCE is comprised of multi-specialty practice groups, ambulatory sites and clinics, physician practices and clinical service lines.


Luminis Health is an Equal Opportunity Employer (EOE)



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