Outcomes Executive

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Act as the key strategic partner to C-suite and senior leadership within a designated portfolio of enterprise payer accounts.

• Manage the complete client relationship encompassing quality, risk, network, and regulatory interactions.

• Establish and nurture executive-level relationships through on-site engagements, quarterly business reviews, and proactive outreach.

• Document the enterprise priorities for each plan and create and implement annual account strategies that focus on retention, optimization, and growth.

• Examine plan membership, line-of-business composition, and product usage data to uncover opportunities and translate insights into pipeline and sales strategy.

• Position Veradigm's risk adjustment and quality solutions in alignment with each plan's annual program cycle.

• Promote payer-provider clinical data exchange solutions utilizing Veradigm’s provider network and data resources.

• Drive achievement of ACV quotas and MBO performance through effective pipeline management, forecasting, and opportunity progression.

• Navigate payer procurement, security review, and contracting processes to finalize enterprise agreements and data usage terms.

• Advocate for client needs internally, coordinate cross-functional issue resolution, and represent the payer perspective in roadmap and strategy discussions.

• Collaborate with Consulting, Support, and A/R to ensure reliable delivery and address at-risk situations proactively to maintain retention.

• Conduct whitespace and competitive analysis to broaden Veradigm’s market presence and identify new use cases.

⛳️ Requirements

• Extensive experience managing strategic relationships with enterprise payer accounts.

• Profound understanding of risk adjustment and quality programs, including HEDIS and Medicare Advantage Stars.

• Familiarity with payer-provider clinical data exchange.

• Knowledge of payer medical economics, quality and risk performance, and regulatory requirements.

• Experience engaging with C-suite and senior functional leadership.

• Proficient in annual account planning and quarterly business review processes.

• Capability to analyze plan membership, line-of-business composition, and product utilization data.

• Understanding of Medicare Advantage, Medicaid, commercial, and ACA lines of business.

• Knowledge of chart retrieval and review, supplemental data submission, gap identification and resolution, and audit readiness.

• Grasp of clinical data acquisition, interoperability compliance, and prior authorization workflows.

• Proven ability to drive ACV quota attainment and MBO performance through effective pipeline management and opportunity progression.

• Experience navigating payer procurement, security reviews, contracting, legal, InfoSec, and privacy processes.

• Working knowledge of CMS and NCQA program mechanics, risk adjustment models and submissions, RADV audit exposure, HEDIS measure specifications, Medicare Advantage Stars, and federal interoperability and prior authorization regulations.

• Must have legal authorization to work in the United States or Canada.

• Visa sponsorship is not available.

🏝️ Benefits

• Holidays

• Vacation

• Medical insurance

• Dental insurance

• Vision insurance

• Company-paid life insurance

• Retirement savings

• Professional development opportunities

• Flexible work arrangements/tools to support employees in bringing their best selves to work