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About the role
- Provider Engagement Account Executive developing partnerships with healthcare providers and networks. Collaborating for improved care delivery and implementing strategies for performance improvement.
Responsibilities
- Develop strategic partnerships between the health plan and the contracted provider networks serving our communities
- Cultivate client relations and collaborate with providers to ensure delivery of the highest level of care to our members
- Participate in the development of network management strategies
- Creates strategic initiatives for performance improvement
- Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices
- Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care
- Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets
- Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)-C-suite Level
- Expert proficiency in tools and value-based performance (VBP) in order to educate providers resulting in improved provider performance
- Resolves provider issues as needed for resolution to internal partners and creating efficiencies to prevent continued concerns
- Receive and effectively respond to external provider related issues
- 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, EDI solicitation and related topics
- Evaluates provider performance and develops strategic plan to improve performance
- Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
- Acts as a lead for the external representatives
- Coaches and trains external representatives
- Ability to travel locally 4 days a week
- Performs other duties as assigned
- Complies with all policies and standards
Requirements
- 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
- Executive level exposure and ability to influence desired outcomes, innovation, performance, member improvements, growth and Provider retention
- Ability to synthesize complex issues at multiple organizational levels, externally and internally across multi-disciplinary teams
- Highly proficient in HEDIS/Quality measures, cost and utilization.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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