RN, Regulatory Compliance Quality Specialist
Jefferson Health Plans•Philadelphia, PA
•Onsite
About The Position
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.
Requirements
- Bachelor’s Degree Healthcare related field of study
- Registered Nurse
- 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
Nice To Haves
- Master’s Degree Healthcare related field
- CPHQ - Certified Professional in Healthcare Quality - National Association for Healthcare Quality within 2 Years
Responsibilities
- 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.
Benefits
- medical (including prescription)
- supplemental insurance
- dental
- vision
- life and AD&D insurance
- short- and long-term disability
- flexible spending accounts
- retirement plans
- tuition assistance
- voluntary benefits
- tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
