RN, Regulatory Compliance Quality Specialist

Job Details
The Quality Specialist ensures the accuracy and regulatory compliance of Jefferson Health's 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.

Job Description

Job Summary

Registered Nurse Preferred

The Quality Specialist ensures the accuracy and regulatory compliance of Jefferson Health's 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.

Essential Functions

• 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 (QC'd).
• 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.

Education - Required

• Bachelor's Degree Healthcare related field of study
• Registered Nurse Preferred

Education - Preferred

• Master's Degree Healthcare related field

Experience - Required

• 5 years in healthcare quality or regulatory reporting

Knowledge, Skills and Abilities - Required

• Knowledge of CMS and Joint Commission standards
• Strong analytical and critical thinking skills
• Attention to detail and accuracy
• Effective communication and collaboration skills

Licenses and Certifications - Preferred

• 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
Regular

Employee Entity
Albert Einstein Medical Center
Primary Location Address
5501 Old York Road, Philadelphia, Pennsylvania, United States of America

Nationally 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 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's 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 8,300 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 diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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