Provider Engagement Account Executive Job at VSV WINS INC, Queens, NY

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  • VSV WINS INC
  • Queens, NY

Job Description

Provider Engagement Account Executive


Location: Queens, NY & The Bronx, NY
Work Type: Hybrid (Remote + 30 50% Field Travel)
Job Type: Full-time | Permanent
Industry: Healthcare
Salary Range: $115,000 $120,000/year

Position Overview

The Provider Engagement Account Executive develops strategic partnerships between Centene's health plan and contracted provider networks to ensure high-quality care delivery for members. This role focuses on value-based care initiatives, provider performance optimization, and relationship management at both operational and executive levels. The position is hybrid, requiring frequent local travel (4 days/week) to meet with providers across Queens and the Bronx.

Key Responsibilities Provider Relationship & Engagement
  • Conduct regular in-person visits with physicians to provide real-time support and performance discussions.

  • Build strong relationships with provider organizations, including C-suite leaders.

  • Serve as the primary escalation point for provider concerns, ensuring timely resolution.

Value-Based & Performance Management
  • Drive value-based care model initiatives and align providers with performance-based agreements.

  • Use data analytics to track provider performance; offer actionable insights to improve quality, cost efficiency, and outcomes.

  • Evaluate provider performance and create strategic plans for improvement.

Problem Resolution & Operational Support
  • Investigate and resolve high-dollar and high-volume claim issues.

  • Educate providers on policies, referral processes, claims submission, EDI, and platform usage.

  • Identify inefficiencies and implement corrective measures to prevent recurring issues.

Data Reporting & Presentations
  • Present Health Benefit Ratio (HBR) analyses and create detailed reports for Joint Operating Committee (JOC) meetings.

  • Develop performance dashboards, reports, and strategic documentation as required.

Leadership & Collaboration
  • Act as a lead and mentor to external representatives; coach and train field staff as needed.

  • Collaborate cross-functionally across health plan teams and external provider groups.

  • Support network management strategies to improve provider satisfaction and retention.

General
  • Travel locally 4 days per week.

  • Perform other duties as assigned and comply with all company policies and standards.

Required Qualifications
  • Bachelor's degree in a related field OR equivalent experience.

  • Master's preferred: MPH, MHA, or MBA.

  • 5+ years experience in:

    • Managed care

    • Provider relations or clinical operations

    • Quality improvement or utilization management

    • Medical group/IPA/health plan environment

  • Strong project management experience within healthcare organizations.

  • Ability to influence executive-level leaders and achieve performance targets.

  • Strong understanding of:

    • HEDIS & quality measures

    • Value-based performance

    • Cost and utilization drivers

  • Ability to synthesize and communicate complex issues to multiple organizational levels.

Job Tags

Permanent employment, Full time, Local area, Remote work,

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