Fidelis Care - New York
Provider Engagement Account Executive
Fidelis Care - New York, Utica, New York, United States
Provider Engagement Account Executive – Fidelis Care, New York
Position Purpose Develop strategic partnerships between the health plan and contracted provider networks, cultivate client relations, and collaborate with providers to ensure delivery of the highest level of care to members.
Key Responsibilities
Serve as a strategic partner/primary contact for hospital systems, multi‑specialty groups, and large PCP groups with Value Based/Risk Components.
Execute provider performance improvement strategies in areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization.
Build strong interpersonal relationships with cross‑functional teams both externally and internally, including C‑suite level interactions.
Educate providers on tools, value‑based performance, and policies, resulting in improved provider performance.
Resolve provider issues, investigate claims, and communicate high dollar and high volume claim issues and changes.
Present detailed HBR analysis and reports for Joint Operating Committee meetings.
Coach and train external representatives; act as lead for external representatives.
Travel locally up to 4 days a week and perform other duties as assigned.
Ensure compliance with all policies and standards.
Qualifications
Bachelor’s degree in a related field or equivalent experience.
Five or more years of managed care or medical group experience in provider relations, quality improvement, utilization management, or clinical operations.
Project management experience in a medical group, IPA, or health plan setting.
Executive level exposure and ability to influence outcomes, innovation, performance, member improvements, growth, and Provider retention.
Ability to synthesize complex issues at multiple organizational levels.
Highly proficient in HEDIS/Quality measures, cost and utilization.
Master's Degree preferred in Public Health (MOH), Health Administration (MHA), or Business Administration (MBA).
Compensation & Benefits Pay Range: $87,700 - $157,800 per year. Compensation may vary based on skills, experience, and education. Benefit package includes health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office).
EEO Statement Fidelis Care is an equal opportunity employer that is committed to diversity. 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 any 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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Position Purpose Develop strategic partnerships between the health plan and contracted provider networks, cultivate client relations, and collaborate with providers to ensure delivery of the highest level of care to members.
Key Responsibilities
Serve as a strategic partner/primary contact for hospital systems, multi‑specialty groups, and large PCP groups with Value Based/Risk Components.
Execute provider performance improvement strategies in areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization.
Build strong interpersonal relationships with cross‑functional teams both externally and internally, including C‑suite level interactions.
Educate providers on tools, value‑based performance, and policies, resulting in improved provider performance.
Resolve provider issues, investigate claims, and communicate high dollar and high volume claim issues and changes.
Present detailed HBR analysis and reports for Joint Operating Committee meetings.
Coach and train external representatives; act as lead for external representatives.
Travel locally up to 4 days a week and perform other duties as assigned.
Ensure compliance with all policies and standards.
Qualifications
Bachelor’s degree in a related field or equivalent experience.
Five or more years of managed care or medical group experience in provider relations, quality improvement, utilization management, or clinical operations.
Project management experience in a medical group, IPA, or health plan setting.
Executive level exposure and ability to influence outcomes, innovation, performance, member improvements, growth, and Provider retention.
Ability to synthesize complex issues at multiple organizational levels.
Highly proficient in HEDIS/Quality measures, cost and utilization.
Master's Degree preferred in Public Health (MOH), Health Administration (MHA), or Business Administration (MBA).
Compensation & Benefits Pay Range: $87,700 - $157,800 per year. Compensation may vary based on skills, experience, and education. Benefit package includes health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office).
EEO Statement Fidelis Care is an equal opportunity employer that is committed to diversity. 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 any 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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