Provider Engagement Account Executive

Queens, NY - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Provider Engagement Account Executive

Location: Queens NY & The Bronx NY
Work Type: Hybrid (Remote 30 50% Field Travel)
Job Type: Full-time Permanent
Industry: Healthcare
Salary Range: $115000 $120000/year

Position Overview

The Provider Engagement Account Executive develops strategic partnerships between Centenes health plan and contracted provider networks to ensure high-quality care delivery for members. This role focuses on value-based care initiatives provider performance optimization and relationship management at both operational and executive levels. The position is hybrid requiring frequent local travel (4 days/week) to meet with providers across Queens and the Bronx.

Key Responsibilities Provider Relationship & Engagement

Conduct regular in-person visits with physicians to provide real-time support and performance discussions.
Build strong relationships with provider organizations including C-suite leaders.
Serve as the primary escalation point for provider concerns ensuring timely resolution.

Value-Based & Performance Management

Drive value-based care model initiatives and align providers with performance-based agreements.
Use data analytics to track provider performance; offer actionable insights to improve quality cost efficiency and outcomes.
Evaluate provider performance and create strategic plans for improvement.

Problem Resolution & Operational Support

Investigate and resolve high-dollar and high-volume claim issues.
Educate providers on policies referral processes claims submission EDI and platform usage.
Identify inefficiencies and implement corrective measures to prevent recurring issues.

Data Reporting & Presentations

Present Health Benefit Ratio (HBR) analyses and create detailed reports for Joint Operating Committee (JOC) meetings.
Develop performance dashboards reports and strategic documentation as required.

Leadership & Collaboration

Act as a lead and mentor to external representatives; coach and train field staff as needed.
Collaborate cross-functionally across health plan teams and external provider groups.
Support network management strategies to improve provider satisfaction and retention.

General

Travel locally 4 days per week.
Perform other duties as assigned and comply with all company policies and standards.

Required Qualifications

Bachelors degree in a related field OR equivalent experience.
Masters preferred: MPH MHA or MBA.
5 years experience in:
- Managed care
- Provider relations or clinical operations
- Quality improvement or utilization management
- Medical group/IPA/health plan environment
Strong project management experience within healthcare organizations.
Ability to influence executive-level leaders and achieve performance targets.
Strong understanding of:
- HEDIS & quality measures
- Value-based performance
- Cost and utilization drivers
Ability to synthesize and communicate complex issues to multiple organizational levels.

Provider Engagement Account Executive Location: Queens NY & The Bronx NY Work Type: Hybrid (Remote 30 50% Field Travel) Job Type: Full-time Permanent Industry: Healthcare Salary Range: $115000 $120000/year Position Overview The Provider Engagement Account Executive develops strategic part...