American Recruiting & Consulting Group
Provider Engagement Account Executive
American Recruiting & Consulting Group, New York, New York, us, 10261
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
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 and create strategic initiatives for performance improvement.
Responsibilities
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.
Create strategic initiatives for performance improvement.
Conduct 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.
Focus 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.
Use data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.
Build strong interpersonal relationships with cross‑functional teams both externally (providers) and internally (health plan), including C‑suite Level.
Demonstrate expert proficiency in tools and value‑based performance (VBP) to educate providers, resulting in improved provider performance.
Resolve provider issues as needed, including resolution to internal partners and creating efficiencies to prevent continued concerns.
Respond to external provider‑related issues effectively.
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, website usage, EDI solicitation and related topics.
Evaluate provider performance and develop a strategic plan to improve performance.
Present detailed HBR analysis and create reports for Joint Operating Committee (JOC) meetings.
Act as a lead for the external representatives.
Coach and train external representatives.
Travel locally 4 days a week.
Perform other duties as assigned.
Comply with all policies and standards.
Qualifications
Bachelor’s degree in a related field or equivalent experience; Master’s preferred in Public Health, Health Administration or Business Administration.
Five or more years of managed care or medical group experience in 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 multidisciplinary teams.
Highly proficient in HEDIS/quality measures, cost and utilization.
Pay Range *** – *** per year
Benefits Competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education and other job‑related factors permitted by law, including full‑time or part‑time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
EEO Statement Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristics protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Required Skills
Candidate must have face‑to‑face experience meeting with providers specifically to have performance‑metrics‑based conversations with providers. 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.
Other Details
Must‑haves: Valid driver’s license.
Years of Experience: 3–5+ years.
Industry Experience: Healthcare.
Education Requirements: Bachelor’s or equivalent experience.
Variable Compensation: Potential annual bonus of 8% based on company hitting annual performance goals.
Available Relocation: None.
Position Type: New.
Sponsorship: No.
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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 and create strategic initiatives for performance improvement.
Responsibilities
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.
Create strategic initiatives for performance improvement.
Conduct 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.
Focus 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.
Use data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets.
Build strong interpersonal relationships with cross‑functional teams both externally (providers) and internally (health plan), including C‑suite Level.
Demonstrate expert proficiency in tools and value‑based performance (VBP) to educate providers, resulting in improved provider performance.
Resolve provider issues as needed, including resolution to internal partners and creating efficiencies to prevent continued concerns.
Respond to external provider‑related issues effectively.
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, website usage, EDI solicitation and related topics.
Evaluate provider performance and develop a strategic plan to improve performance.
Present detailed HBR analysis and create reports for Joint Operating Committee (JOC) meetings.
Act as a lead for the external representatives.
Coach and train external representatives.
Travel locally 4 days a week.
Perform other duties as assigned.
Comply with all policies and standards.
Qualifications
Bachelor’s degree in a related field or equivalent experience; Master’s preferred in Public Health, Health Administration or Business Administration.
Five or more years of managed care or medical group experience in 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 multidisciplinary teams.
Highly proficient in HEDIS/quality measures, cost and utilization.
Pay Range *** – *** per year
Benefits Competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education and other job‑related factors permitted by law, including full‑time or part‑time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
EEO Statement Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristics protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Required Skills
Candidate must have face‑to‑face experience meeting with providers specifically to have performance‑metrics‑based conversations with providers. 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.
Other Details
Must‑haves: Valid driver’s license.
Years of Experience: 3–5+ years.
Industry Experience: Healthcare.
Education Requirements: Bachelor’s or equivalent experience.
Variable Compensation: Potential annual bonus of 8% based on company hitting annual performance goals.
Available Relocation: None.
Position Type: New.
Sponsorship: No.
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