Provider Healthcare Partnership Manager

Title: Provider Engagement Account Executive

Role is Hybrid. Candidate is provide equipment to work remotely from home, but will need to go into the field to meet with Providers 30% - 50%

• Queens, NY, US
• The Bronx, NY, US

Req ID: 1612054

Salary: USD $115,000 – $120,000 / yr

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: 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.