Fidelis Care - New York
Provider Engagement Account Executive
Fidelis Care - New York, Latham, New York, United States
Position Purpose
Develop strategic partnerships between the health plan and 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
Serve as a primary contact for hospital systems, multi‑specialty groups, and large PCP groups with Value Based/Risk components. Execute provider performance improvement strategies in Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, and related areas. Build strong interpersonal relationships with cross‑functional teams externally (provider) and internally (health plan) at C‑suite level. Educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation, and related topics. Resolve provider issues and investigate high dollar & high volume claim issues, presenting detailed HBR analysis and reports for Joint Operating Committee meetings. Coach and train external representatives; act as lead for external representative initiatives. Travel locally up to 4 days a week and perform other duties as assigned while complying with all policies and standards. Qualifications
Bachelor’s degree in related field or equivalent experience. 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 with ability to influence desired outcomes, innovation, performance, member improvements, growth, and provider retention. Ability to synthesize complex issues at multiple organizational levels, internally and externally across multidisciplinary teams. Highly proficient in HEDIS/Quality measures, cost and utilization. Compensation
Pay Range:
$87,700.00 – $157,800.00 per year Benefits
Competitive health insurance and 401(k) plan. Stock purchase plan and tuition reimbursement. Paid time off, holidays, and flexible work options (remote, hybrid, field, or office). 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 characteristic 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.
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Develop strategic partnerships between the health plan and 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
Serve as a primary contact for hospital systems, multi‑specialty groups, and large PCP groups with Value Based/Risk components. Execute provider performance improvement strategies in Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, and related areas. Build strong interpersonal relationships with cross‑functional teams externally (provider) and internally (health plan) at C‑suite level. Educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation, and related topics. Resolve provider issues and investigate high dollar & high volume claim issues, presenting detailed HBR analysis and reports for Joint Operating Committee meetings. Coach and train external representatives; act as lead for external representative initiatives. Travel locally up to 4 days a week and perform other duties as assigned while complying with all policies and standards. Qualifications
Bachelor’s degree in related field or equivalent experience. 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 with ability to influence desired outcomes, innovation, performance, member improvements, growth, and provider retention. Ability to synthesize complex issues at multiple organizational levels, internally and externally across multidisciplinary teams. Highly proficient in HEDIS/Quality measures, cost and utilization. Compensation
Pay Range:
$87,700.00 – $157,800.00 per year Benefits
Competitive health insurance and 401(k) plan. Stock purchase plan and tuition reimbursement. Paid time off, holidays, and flexible work options (remote, hybrid, field, or office). 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 characteristic 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.
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