Provider Engagement Account Executive

About This Role

Develop strategic partnerships and cultivate client relations between the health plan and contracted provider networks to ensure high-level care for members. This role focuses on value-based care initiatives and performance improvement strategies.

Responsibilities

• Conduct regular in-person visits with physicians to provide real-time support and identify opportunities for improvement in patient care and clinical practices
• Focus on value-based care model initiatives, collaborating with physicians to identify and align performance-based agreements
• Use data analytics to track and monitor provider performance, offering actionable feedback to optimize care delivery and meet key performance targets
• Build strong interpersonal relationships with cross-functional teams both externally (provider) and internally (health plan) at C-suite Level
• Educate providers on tools and value-based performance to improve provider performance
• Resolve provider issues as needed for resolution to internal partners and create efficiencies to prevent continued concerns
• Investigate, resolve and communicate provider high dollar and high volume provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, and EDI solicitation
• Evaluate provider performance and develop a strategic plan to improve performance
• Present detailed HBR analysis and create reports for Joint Operating Committee (JOC) meetings
• Act as a lead for the external representatives, coaching and training them
• Ability to travel locally 4 days a week

Requirements

• 5+ years of managed care or medical group experience, provider relations, quality improvement, utilization management, or clinical operations
• Project management experience at a medical group, IPA, or health plan setting
• Executive level exposure and ability to influence desired outcomes
• Ability to synthesize complex issues at multiple organizational levels
• Highly proficient in HEDIS/Quality measures, cost and utilization

Qualifications

• Bachelor's degree in related field or equivalent experience. Master's Degree preferred in Public Health (MOH), Health Administration (MHA) or Business Administration (MBA).
• Five or more years of managed care or medical group experience, provider relations, quality improvement, utilization management, or clinical operations. Project management experience at a medical group, IPA, or health plan setting.

Nice to Have

• Master's Degree in Public Health (MOH)
• Master's Degree in Health Administration (MHA)
• Master's Degree in Business Administration (MBA)

Benefits