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Regulatory Operation Mgr

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Job ID REQ_110040 FACILITY Rochester General Hospital LOCATION Rochester, New York


Manages the day to day operations and assists Senior Director, Manager and Office of Clinical Regulatory Compliance.  Independently conducts work, determining method of completion, resource, data and information requirements, as well as analysis techniques.  Work is often confidential, sensitive, and/or critical in nature and requires a broad working knowledge of organizational and hospital practices, internal and external resources, programs and services to complete. Works closely with all levels of Rochester Regional Health and external agency staff.  The ideal candidate is eager and willing to handle the diverse responsibilities of the job with a helpful, professional attitude and friendly, “can-do” demeanor.  Superior organizational and computer skills, attention to detail, resourcefulness and proactivity are essential in carrying out responsibilities.     

STATUS: Full Time

LOCATION: Rochester General Hospital

SCHEDULE: Monday-Friday


o    Bachelor degree or equivalent combination of education and/or experience.
o    Advanced computer and keyboard skills including Word, Excel spreadsheets and graphics, databases, internet search, and using an EMR.
o    Excellent written, verbal communication and organization skills and the ability to work independently and in a collaborative team environment.
o    Experience with NYS Health Commerce System preferred.
o    Experience writing and/or managing document control systems preferred.
o    Medical Terminology experience preferred.


Policy Management:
o    Independently manages and coordinates processing and posting of all Rochester Regional Health System Administrative policies. Manages communications and processes to meet regulatory requirements for timing of policy review and recommends cross system consolidation where applicable.  Provides administrative support to the Rochester Regional Health Administrative Policy Committee and other committees as requested by Sr. Director Clinical Regulatory Compliance.  
o    Retrieves and submits policies as needed for litigation/risk management cases.

NYS Health Commerce System:
o    Maintains highest level of access to HCS (Health Commerce System – secure New York State Department of Health {NYSDOH} website) as an “Organizational Security Coordinator” for sites within Rochester Regional Health (RRH).  Performs activities daily in HCS and is fluent in operations of the various areas within the website.

Regulatory Survey Administrative Support:
o    Plans and coordinates activities for The RGH Joint Commission surveys – produces a multitude of communications and notifications prior to and during actual surveys, maintains resources on the Rochester Regional Health portal for internal users, creates and delivers meeting invites to participating individuals, schedules rooms for various meetings, order meals, gathers and maintains official notebook of required documents for Joint Commission survey.  Maintains evidence binder for ongoing readiness.
o    Executes standard, special or ongoing surveys or studies or requests for data/information; complies, tabulates and analyzes data, and prepares reports/ recommendations, usually for action by Sr. Director or Senior Level staff.
o    Provides support and communications to executive leadership team related to all regulatory agency visits.
o    Receives all notifications, Health Advisories and Dear Administrator letters from NYSDOH.  Independently reviews information and distributes to appropriate executives, senior leaders and medical staff as outlined in the notifications.
o    Independently contacts appropriate department/individuals for documentation requested by the Office of Professional Discipline Investigations.  Obtains and prepares documentation required for submission and submits in a timely manner.
o    Independently retrieves information/documentation for any onsite Department of Health investigations.

Administrative support to Senior Director and Manager of Clinical Regulatory Compliance:
o    Provides overall administrative support to departmental leadership
o    Schedules meetings, including location, phone conference, and sends meeting reminders and messages to participants, organizes resources as needed for the meeting, takes and distributes minutes.
o    Maintains and coordinates complex calendars for Sr. Director and Manager for Clinical Regulatory Compliance.
o    Creates reports, power points, data entry as requested by leadership in a timely manner.

Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran
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