Provider Engagement Account Executive

Provider Engagement Account Executive – Fidelis Care, New York

Join us to help transform the health of our communities with a strategic partner role focused on provider engagement.

Develop strategic partnerships between the health plan and contracted provider networks, cultivate client relationships, 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 drive performance improvement initiatives.

• Conduct 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 align 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) – C‑suite level.
• Leverage expertise in tools and value‑based performance (VBP) to educate providers, resulting in improved performance.
• Resolve provider issues, triage and coordinate with internal partners to prevent repeat concerns.
• Respond to external provider‑related issues and investigate, resolve, and communicate high‑dollar and high‑volume claim issues.
• Educate providers regarding policies and procedures related to referrals, claims submission, web‑site usage, EDI solicitation, and related topics.
• Evaluate provider performance and develop a strategic plan to improve performance.
• Present detailed H  analysis and create reports for Joint Operating Committee meetings (JOC).
• Act as lead for external representatives and coach/train them.
• Travel locally 4 days a week.
• Perform other duties as assigned.
• Comply with all policies and standards.

Bachelor’s degree in a related field or equivalent experience.

Master’s Degree preferred in Public Health (MPH), Health Administration (MHA), or Business Administration (MBA).

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 desired outcomes, innovation, performance, member improvements, growth and provider retention.

Proficiency in synthesizing complex issues across multiple organizational levels, externally and internally across multidisciplinary teams.

High proficiency in HEDIS/Quality measures, cost and utilization.

$86,000.00 – $ per year.

Comprehensive benefits package including 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.

Fidelis Care is an equal opportunity employer 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.