Job Description Coordinates, directs, and manages the activities of the HEDIS AND CAHPS quality management program including HEDIS data collection, analysis and submission of results. Is responsible for the development of strategies to drive the improvement of HEDIS scores through coordinated market and enterprise level of interventions. Leads a dedicated effort in establishing programs to improve STAR ratings throughout the enterprise focusing on market level efforts. Establishes strategic plans, policies, and procedures at all levels and with all critical operation departments to ensure quality programs will meet or exceed guidelines or requirements. Develops performance indicators in response to data results. Attends required meetings; education and training programs to enhance skills. Must be able to Supervise, coordinate and insure the timely and accurate submission of the HEDIS data. Must work collaboratively with the NCQA certified auditor and ensures compliance in accordance with state and federal and accrediting standards and regulations. Is responsible to lead and grow the efficiency and effectiveness of the HEDIS effort at the enterprise level. Will be responsible in navigating the market and enterprise environments in order to successfully support the HEDIS-STAR ratings effort.

Development, implementation and management of the HEDIS and CAHPS quality improvement program and meet all regulatory requirements. Demonstrated ability to lead a diverse team to a goal that requires innovation and cooperation across an enterprise Oversight and management of HEDIS reporting, quality consultation to other departments, collecting and analyzing data to identify opportunities for improving member satisfaction and health outcomes, and developing and implementing initiatives to address those opportunities. Knowledge of state, federal and accrediting standards and/or regulations. Computer literate in Microsoft Office, Word, Excel Exceptional organizational skills as it relates to data collection, assessment and reporting. Professional communication skills. Supports and demonstrates continuous quality and services. Reports problems and unusual events through appropriate channels. Required Experience Minimum Requirements: Extensive knowledge of Quality program implementation and management, Medicare, HEDIS, Pay for Quality or similar physician bonus programs. Minimum of six years experience working in managed care with emphasis in quality improvement; Minimum of three years of experience in managing HEDIS process.

Preferred Requirements: Bachelor in health related field. Registered Nurse degree, with an active, unrestricted nursing license in the state. Please direct all inquires to Dave Mara at 804.402.8088 or email him at dmara@nexushc.com. For additional career opportunities, go to www.nexushc.com