Provider Engagement Account Executive (QueensBronx, NY Hybrid)

Position Purpose : As a Provider Engagement Account Executive you will own the strategic partnerships between the health plan and our contracted provider networks in the Queens and Bronx markets. You will serve as the primary C-suite liaison driving performance improvement value-based care initiatives and operational excellence.

Key Responsibilities :

Strategic Relationship Management : Cultivate deep relationships with hospital systems and large multi-specialty groups. Act as the primary point of contact for C-suite executives and provider leadership.

Performance Improvement : Drive provider performance in critical metrics including HEDIS / Quality Health Benefit Ratio (HBR) risk adjustment and cost utilization.

Value-Based Care : Lead initiatives to align providers with value-based performance (VBP) agreements. Use data analytics to track performance and offer actionable feedback to optimize patient care and cost-efficiency.

Operational Solutions : Investigate and resolve complex high-volume or high-dollar claim issues. Educate providers on policies referrals claims submission and EDI tools to prevent recurring issues.

Reporting & Analytics : Present detailed HBR analysis and create comprehensive reports for Joint Operating Committee (JOC) meetings.

Leadership : Act as a lead for external representatives providing coaching training and mentorship to the broader team.

Field Presence : This is a hybrid role requiring local travel (up to 4 days / week) to conduct in-person visits with physicians and administrators for real-time support and strategy alignment.

Qualifications :

Education & Experience :

Bachelors degree in a related field (or equivalent experience) is required.

Masters Degree in Public Health (MPH) Health Administration (MHA) or Business Administration (MBA) is highly preferred.

5 years of experience in managed care medical group operations provider relations quality improvement or utilization management.

Key Skills & Competencies :

Deep Knowledge of Quality Metrics : Highly proficient in HEDIS measures risk adjustment cost containment and utilization management.

Project Management : Proven ability to manage complex projects within a medical group IPA or health plan setting.

Executive Presence : Ability to influence desired outcomes at the executive level and synthesize complex issues for multi-disciplinary teams.

Technical Proficiency : Strong understanding of value-based performance tools and data analytics.

Additional Information :

Why This Role Matches Your Career :

Impact : You are not just managing accounts; you are transforming healthcare delivery for underserved populations in New York.

Growth : Join a Fortune 500 industry leader with clear paths for advancement.

Compensation : Competitive base salary ($115000 $120000) with a comprehensive benefits package.

Benefits :

Competitive Pay & Performance Incentives

Medical Dental and Vision Insurance

401(K) with company match

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off Holidays

Next Steps : Click Apply Now to submit your resume. Our Talent Team will review your application immediately.

Remote Work : Yes

Employment Type : Full-time

Key Skills

Business Development,Customer Service,Revenue Growth,ABC Analysis,Account Management,Communication,CRM,Excel,Salesforce,PMP,Customer Relationships,Business Relationships,Sales Goals,Sales Process,CPA

Experience : years

Vacancy : 1