Position Title: Provider Engagement Account Executive
Work Location: Queens, NY/The Bronx, NY
Assignment Duration: Full-Time
Work Arrangement: On-site with local travel 4 days a week

Position Summary:

• 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.
• Background & Context: Participate in the development of network management strategies. Creates strategic initiatives for performance improvement.

Key Responsibilities:

• 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

Qualification & Experience:

• Bachelor’s degree in a 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.

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 115000.00/Yearly.