Manager, Cancer Accreditation and Education
Sinai Health System
Position Summary
The Manager, Cancer Accreditation and Education is responsible for leading oncology accreditation efforts and designing, implementing, and evaluating educational programs that support a high-performing learning environment. This role ensures compliance with regulatory standards, oversees tumor registry operations, and manages accreditation processes across both North and South campuses.
The Manager collaborates with interdisciplinary teams to maintain accreditation readiness, enhance clinical quality, and promote continuous learning aligned with organizational goals.
Key Responsibilities
Accreditation & Regulatory Compliance
- Lead all activities related to ACS Commission on Cancer (CoC) accreditation for North and South campuses.
- Ensure compliance with Joint Commission (TJC), HFAP, and IDPH standards.
- Prepare, compile, and submit required data for accreditation surveys.
- Serve as the primary liaison and point of contact for surveyors and regulatory bodies.
- Develop, maintain, and monitor regulatory work plans, identifying risks and mitigation strategies.
- Lead survey preparation efforts, including logistics and cross-functional coordination.
Tumor Registry & Program Oversight
- Manage the tumor registry team, including staffing, performance management, audits, and payroll.
- Ensure accurate and timely collection, reporting, and analysis of oncology data.
- Oversee tumor board operations across campuses, including:
- Scheduling and coordination
- Documentation and meeting minutes
- Data integrity and compliance with CoC standards
Education & Staff Development
- Assess learning needs and develop education strategies for oncology and infusion staff.
- Design and deliver training programs, including:
- Instructor-led training
- Blended learning solutions
- Competency assessments
- Provide annual competencies and ongoing education to ensure high-quality oncology care.
- Conduct monthly educational sessions and seminars for staff.
- Develop user-friendly training materials and resources.
- Promote a culture of continuous learning and professional development.
Quality, Compliance & Performance Improvement
- Perform regular audits and rounding to ensure compliance with regulatory standards.
- Use data and outcomes to inform education and performance improvement initiatives.
- Collaborate with leadership to align education programs with organizational goals.
- Monitor program effectiveness and recommend improvements.
Leadership & Collaboration
- Partner with the System Oncology Manager, providing backup support as needed.
- Communicate accreditation status, risks, and compliance updates to leadership.
- Lead interdisciplinary teams, committees, and workgroups.
- Foster strong relationships across departments to support operational and clinical excellence.
Minimum Qualifications
Education
- Master’s degree in Healthcare, Education, Nursing, or related field (or equivalent experience)
Experience
- Minimum 10 years of experience in:
- Training and development
- Instructional design
- Healthcare education
- Experience with oncology programs and accreditation standards preferred
Knowledge, Skills & Abilities
- Strong expertise in:
- Adult learning principles
- Curriculum design and instructional methods
- Performance improvement and change management
- Knowledge of ACS CoC, TJC, HFAP, and IDPH standards
- Excellent communication, presentation, and facilitation skills
- Strong organizational and project management abilities
- Demonstrated leadership and team management experience
- Ability to manage multiple priorities and work independently or collaboratively
- Advanced proficiency with Microsoft Office and related tools
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