Program Manager

Department Overview

The Program Manager, HB2697 Staffing Governance & Compliance is responsible for the day-to-day execution, coordination, and continuous improvement of OHSU’s staffing governance and regulatory compliance processes under Oregon House Bill (HB) 2697.

Reporting to the Senior Director, this role operationalizes governance structures, workflows, and compliance systems, ensuring that staffing committees, escalation pathways, and regulatory processes function consistently, efficiently, and in alignment with organizational expectations.

The Program Manager serves as the primary system operator for staffing governance—coordinating committee activities, managing staffing plan workflows, tracking compliance performance, and supporting regulatory response processes.

This role does not establish staffing policy, staffing levels, or governance structures, but instead ensures the reliable execution, documentation, and monitoring of those established by executive leadership, clinical leadership, and labor agreements.

The Program Manager partners closely with the Senior Director and cross-functional stakeholders (including but not limited to: Legal, Labor Relations, Regulatory Affairs, Nursing, Finance, and operations leadership) to ensure a standardized, audit-ready, and defensible governance system that minimizes compliance risk and supports effective decision-making.

Function/Duties of Position

Staffing Governance & Committee System Leadership

• Monitors and manages governance operations (e.g., decision timelines, escalation utilization, workflow adherence) and escalates performance gaps or risks to the Senior Director 
• Supports Executive Governance Council by preparing analyses, summaries, and escalation materials for high-risk or unresolved issues
• Coordinates day-to-day operations of the HB2697 staffing governance system, including staffing committees (Professional Technical & Service and Nursing), escalation pathways, and executive governance processes 
• Manages logistics, facilitation support, and workflow coordination for governance forums (Staffing Committee, Steering Committee, Executive Governance Council) to ensure timely, consistent, and compliant execution 
• Partners with committee co-chairs, Labor Relations, and operational leaders to prepare structured agendas, decision-support materials, and ensure readiness for governance discussions 
• Ensures adherence to established governance processes, including decision rights, quorum requirements, documentation standards, and escalation protocols 
• Tracks committee decisions, action items, and follow-ups to ensure closure and accountability 
• Implements and maintains standardized workflows for staffing plan development, review, approval, and revision 
• Ensures appropriate use of escalation pathways and facilitates coordination when governance thresholds (e.g., quorum, impasse) are not met 
• Provides leadership with clear, accurate visibility into governance activities, risks, and process performance through reporting and documentation

Safe Staffing Plan Governance & Administration

• Manages the end-to-end lifecycle of the enterprise staffing plan portfolio, including intake, tracking, version control, review workflows, approvals, and submission readiness 
• Ensures staffing plans meet defined statutory, operational, and documentation requirements prior to submission, based on established standards and guidance 
• Maintains centralized documentation and audit-ready records of all staffing plans and revisions 
• Tracks plan status, approvals, and timelines, ensuring transparency and accountability across stakeholders 
• Supports alignment of staffing plan documentation with organizational standards and regulatory expectations; escalates inconsistencies or risks.

Data, Reporting, & Audit Readiness

• Maintains data infrastructure, reporting tools, and dashboards supporting staffing governance, compliance tracking, and risk visibility 
• Ensures accuracy, completeness, and audit readiness of all governance, compliance, and investigation data and documentation 
• Produces routine and ad hoc reports on staffing plans, deviations, escalations, investigations, and compliance performance 
• Develops and maintains centralized dashboards to monitor key indicators (e.g., deviations, investigations, penalties, plan approvals) 
• Tracks and reports compliance-related financial impacts (e.g., penalties, staffing deviations) in partnership with Finance 
• Uses data to identify trends, surface risks, and support decision-making by leadership.

Regulatory Compliance & Risk Management

• Executes and maint