Provider Engagement Account Executive

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

📋 Description

• Cultivate and sustain strategic alliances between the health plan and its contracted provider networks.

• Propel value-based care initiatives, enhance provider performance, and improve member outcomes.

• Act as a trusted advisor to both providers and internal stakeholders, utilizing data-driven insights, operational assistance, and performance enhancement strategies.

• Function as the primary strategic partner and main point of contact for hospital systems, multispecialty groups, and large primary care organizations.

• Offer guidance on the design of value-based programs, reporting tools, performance metrics, and financial methodologies.

• Provide training, education, and continuous support regarding value-based programs, reporting, and operational processes.

• Oversee and maintain the portfolio of value-based payment contracts, address operational challenges, rectify data discrepancies, and facilitate payment execution.

• Analyze complex datasets using Excel, dashboards, and various reporting tools.

• Create executive-level presentations that translate provider performance data into actionable insights and recommendations.

• Lead process improvement initiatives, enhance operational efficiencies, and develop best-practice playbooks.

• Implement provider performance improvement strategies across quality metrics, pay-for-performance, cost, and utilization initiatives.

• Establish and nurture relationships with provider leaders, executive stakeholders, and cross-functional internal teams.

• Assist in shaping the contracting strategy with insights regarding provider relationships, market dynamics, and organizational factors.

• Review, interpret, and apply the language of value-based and provider contracts.

• Educate providers on policies, procedures, claims submission requirements, referral processes, EDI capabilities, and tools available on the provider portal.

• Offer leadership, guidance, and mentorship to team members facing providers and external partners.

• Address provider issues and create efficiencies to mitigate recurring challenges.

• Carry out additional duties as assigned.

⛳️ Requirements

• Candidates must reside or currently live in Kentucky.

• Must have authorization to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

• Bachelor's degree in a related field or equivalent experience is required.

• A minimum of five years of experience in managed care, medical group settings, provider relations, quality improvement, utilization management, or clinical operations.

• Experience in project management within a medical group, IPA, or health plan environment.

• Exposure to executive-level operations with the ability to influence outcomes, foster innovation, enhance performance, improve member services, support growth, and ensure provider retention.

• Capability to synthesize complex issues across various organizational levels and multidisciplinary teams.

• High proficiency in HEDIS/Quality measures, cost, and utilization metrics.

• Willingness to travel locally four days a week, or as required.

• Must adhere to organizational policies, standards, and regulatory requirements.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement assistance.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Potential for additional incentives as part of total compensation.

• An equal opportunity employer dedicated to promoting diversity.