Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. Our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today. The Enterprise Manager, Clinical Risk and Regulatory Management directs the enterprise regulatory management program oversees performance improvement activities, and supports all activities to ensure successful review by all regulatory and accreditation bodies such as The Joint Commission, California Department of Public Health, and Centers for Medicare and Medicaid Services. Directs the patient safety and risk reduction program through coordination of proactive risk assessments, review of incidents and insurance grievances, designs and implements risk reduction strategies and coordinates Failure Mode and Effect Analysis and root cause analyses when indicated to identify and mitigate risk. Directs and oversees survey activities and regulatory compliance with particular focus on The Joint Commission readiness, CDPH interactions for complaints, surveys and facility renovation and expansion, accreditation and other accrediting /regulatory bodies as needed. As a successful candidate, you will focus on: Risk Reduction and Patient Safety
Execute enterprise-wide clinical risk and regulatory management programs. Direct the reviews of the enterprise Clinical Risk Management program. Direct the enterprise incident reporting system to ensures the collection, evaluation, and reports on events and incidents. Oversee statistical analysis and trending of events and executes the proactive assessment and develops mitigation and sustainable strategies for clinical risk vulnerabilities. Act as a leader and role model to develop and promote a workplace culture that values diversity of thought, promotes integrity and creates an atmosphere that supports coaching and fosters accountability through JUST CULTURE; engage as a team player across peer group and in influencing the COH Leadership Team; and continuously improve self and department. (e.g., employee engagement Survey, staff feedback, corporate social responsibility, personal professional development, peer, and external results). Advise and assist enterprise departments; and become a trusted advisor to stakeholders and related risk and regulatory management functions. Oversee the investigations of the enterprise serious events. In conjunction with enterprise leadership and legal counsel, assists with communication and documentation of errors or serious events in accordance with legal requirements and/or regulatory/accreditation requirements. Directs annual proactive risk assessments to identify opportunities to improve reliability in processes and reduce risk. Executes Failure Mode Effect Analyses and Root Cause Analyses investigations and develops action orientation recommendations to correct and/or eliminate deficiencies that may adversely affect patients, visitors and staff.
Survey and Regulatory Compliance Leadership
Executes enterprise-wide regulatory management programs. Provides input on data for critical reporting components for trending and mitigation actions to the appropriate committees, departments, individuals, and regulatory agencies. Executes on the remediation and closure of internal and external (e.g. assessments, surveys, inspections) enterprise risk and regulatory management. Effectively partner with enterprise leaders to provide subject matter expertise in the joint execution to assessments for their areas of responsibility for exposures to loss and unsafe processes and conditions. Collaborates with the Quality and Regulatory staff in matters related to regulatory compliance, policy planning and implementation. Collaborates with the development and revisions of policy and procedures as requested. Directs the product recall program (except for pharmaceuticals and blood products) and ensure robust participation to reduce the likelihood that problem products are utilized in the clinical setting. Directs orientation and continuing education programs for providers, management and staff to enhance awareness of their role in high reliability, just culture, patient safety, clinical risk reduction and event reporting. Ensures compliance s with various codes, laws, rules and regulations concerning patient care/safety, including those mandates by County, State and Federal agencies.
Communication of Strategic Information
Identify and evaluate performance of meaningful clinical risk metrics Communicates hospital performance to the board of directors by working with the Enterprise VP of Quality on reports regarding clinical risk areas. Provides input on data for critical reporting components for trending and mitigation actions to the appropriate committees, departments, individuals, and regulatory agencies. Executes on the remediation and closure of internal and external (e.g. assessments, surveys, inspections) enterprise risk and regulatory management. Effectively partner with enterprise leaders to provide subject matter expertise in the joint execution to assessments for their areas of responsibility for exposures to loss and unsafe processes and conditions. Assists administration in the review of clinical contracts to ensure that the language and insurance coverage protects the organizations from liability. Provides clinical risk management information on medical and allied health staff to Medical Staff Services for use in the credentialing process. Liaison with attorneys for discovery and coordinating depositions. - Assesses the ongoing culture of safety and leads actions to strengthen the culture
Qualifications
Your qualifications should include: Minimum Education:
Minimum Experience:
5 years of clinical acute care experience 3 years of experience in an administrative, consultative or managerial capacity - 2 years of experience managing staff members
Preferred Certification/Licensure:
City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location. City of Hope is an equal opportunity employer. To learn more about our Comprehensive Benefits, please CLICK HERE. |
City of Hope
$56.43 - $94.23 / hr
Dec 05, 2025