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Trillium Community Health Plan · 2 days ago

Provider Engagement Account Executive

United States

Full-time

Remote

Mid, Senior Level

$88K/yr - $158K/yr

5+ years exp

Trillium Community Health Plan is transforming the health of communities through strategic partnerships. The Provider Engagement Account Executive will develop and manage relationships with provider networks to ensure high-quality care delivery and implement performance improvement strategies.

Health CareHealth DiagnosticsInsuranceMedical

Responsibilities

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

Creates strategic initiatives for performance improvement

Serve as a strategic partner/primary contact for hospital systems, multi-specialty groups, and large PCP groups with Value Based/Risk Components

Executes provider performance improvement strategies in the following areas Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc

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 relationsQuality improvementUtilization managementHEDIS/Quality measuresProject managementCoachingTrainingStrategic planningInterpersonal skills

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