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Fidelis Care - New York · 2 days ago

Provider Engagement Account Executive

East Syracuse, NY

Full-time

Hybrid

Mid, Senior Level

$86K/yr - $155K/yr

5+ years exp

Fidelis Care is transforming the health of communities, and they are seeking a Provider Engagement Account Executive to develop strategic partnerships with contracted provider networks. The role involves cultivating client relations, collaborating with providers to enhance care delivery, and utilizing data analytics to track performance and implement improvement strategies.

AssociationCommunitiesHealth CareInsurance

Responsibilities

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

Focuses 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

Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets

Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)-C-suite Level

Expert proficiency in tools and value-based performance (VBP) in order to educate providers resulting in improved provider performance

Resolves provider issues as needed for resolution to internal partners and creating efficiencies to prevent continued concerns

Receive and effectively respond to external provider related issues

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, web site usage, EDI solicitation and related topics

Evaluates provider performance and develops strategic plan to improve performance

Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)

Acts as a lead for the external representatives

Coaches and trains external representatives

Ability to travel locally 4 days a week

Performs other duties as assigned

Complies with all policies and standards

Qualification

Provider relationsData analyticsValue-based careHEDIS/Quality measuresProject managementCoachingInterpersonal skillsCommunication

Required

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 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 multi-disciplinary teams

Highly proficient in HEDIS/Quality measures, cost and utilization

Ability to travel locally 4 days a week