System Director, Accreditation and Regulatory Affairs

Kirby Bates Associates has been exclusively retained by Duke University Health System (DUHS) to conduct the search for the next System Director, Accreditation & Regulatory Affairs.

Duke University Health System (DUHS) is one of the nation's preeminent academic health systems, offering world-class clinical care, groundbreaking research, and a culture deeply committed to quality, safety, and patient-centered excellence. Spanning three hospitals and a comprehensive network of outpatient and ambulatory locations, DUHS delivers leading-edge care to patients across the region and the country.

The System Director, Accreditation & Regulatory Affairs will provide strategic leadership and operational oversight for accreditation, regulatory compliance, and policy management across all DUHS hospitals and ambulatory sites. This key system leader will serve as the organization's subject matter expert for The Joint Commission, CMS, state and federal investigative agencies, and all regulatory bodies—ensuring that Duke maintains continuous readiness and a proactive, collaborative approach to compliance, safety, and quality.

This role reports to senior system leadership and leads a centralized team responsible for driving alignment, consistency, and enterprise-wide regulatory preparedness.

Opportunity Highlights :

• Shape systemwide accreditation and regulatory strategy across one of the nation's most respected academic health systems.
• Serve as the primary system liaison to external agencies including The Joint Commission, CMS, NCDHHS, and federal oversight bodies.
• Lead continuous readiness efforts across DUHS's hospitals and ambulatory practices, ensuring proactive compliance and seamless preparation for planned and unannounced surveys.
• Build and refine an enterprise accreditation and regulatory framework , strengthening infrastructure, processes, tools, and communication systems across all sites.
• Partner with senior executives and clinical leaders —including hospital presidents, medical staff, quality and patient safety, compliance, legal, and performance services.
• Lead a high-impact, centralized team , fostering shared best practices, cross-campus consistency, and a cohesive approach to regulatory oversight.
• Influence organizational culture , promoting transparency, safety, quality, and system-wide effectiveness in every aspect of regulatory and policy management.

Qualifications :

EEO Statement

Kirby Bates Associates is an EEO / AA Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender, gender identity and expression, national origin, age, disability or protected veteran status. We celebrate diversity and are committed to creating an inclusive environment for all of our associates.