Provider Engagement Account Executive

Queens, NY - USA

Monthly Salary: Not Disclosed

Posted on: 16 hours ago

Vacancies: 1 Vacancy

Job Summary

Title: Provider Engagement Account Executive

Type: Hybrid

Locations: Queens NY US / The Bronx NY US

Job description

Position Purpose: 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

Education/Experience:

Bachelors degree in related field or equivalent experience.
Masters 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.

Title: Provider Engagement Account Executive Type: Hybrid Locations: Queens NY US / The Bronx NY US Job description Position Purpose: Develop strategic partnerships between the health plan and the contracted provider networks serving our communities. Cultivate client relations and collaborate with ...

Title: Provider Engagement Account Executive

Type: Hybrid

Locations: Queens NY US / The Bronx NY US

Job description

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

Education/Experience:

Bachelors degree in related field or equivalent experience.
Masters 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.