Provider Engagement Account Executive

Position Purpose: The Provider Engagement Account Executive will develop and maintain strategic partnerships between the health plan and contracted provider networks to advance value-based care initiatives, improve provider performance, and enhance member outcomes. Serve as a trusted advisor to providers and internal stakeholders by delivering data-driven insights, operational support, and performance improvement strategies. Contribute to network management, contracting, and value-based payment (VBP) program success through program administration, relationship management, analytics, education, and process optimization.

Key Details:Ability to travel several days a week or as required. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

• Serve as the primary strategic partner and point of contact for hospital systems, multispecialty groups, and large primary care organizations participating in value-based and risk-based arrangements.

• Act as the Value-Based Program (VBP) subject matter expert by providing guidance on program design, reporting tools, performance metrics, and financial methodologies.

• Deliver training, education, and ongoing support to provider organizations and health plan teammates to ensure proficiency with VBP programs, reporting, and operational processes.

• Manage and maintain the VBP contract portfolio by resolving operational issues, correcting data discrepancies, and supporting payment execution.

• Analyze and interpret complex datasets using Excel, dashboards, and reporting tools to identify performance trends, risks, and improvement opportunities.

• Develop and deliver executive-level presentations that translate provider performance data into actionable insights and recommendations.

• Drive VBP success through process improvement initiatives, operational efficiencies, and development of best-practice playbooks.

• Execute provider performance improvement strategies across VBPs, including quality, pay-for-performance (P4P), cost, and utilization initiatives, by evaluating performance, developing action plans, and monitoring progress toward established goals.

• Build and maintain strong relationships with provider leaders, executive stakeholders, and cross-functional internal teams.

• Support contracting strategy by providing insights on provider relationships, market dynamics, and organizational considerations that influence negotiations and performance outcomes.

• Review, interpret, and apply value-based and provider contract language to support operational execution and issue resolution.

• Educate providers on policies, procedures, claims submission requirements, referral processes, EDI capabilities, and provider portal tools.

• Provide leadership, guidance, and mentorship to provider-facing team members and external partners.

• Resolves provider issues as needed for resolution to internal partners and creating effeciencies to prevent continued concerns.

• Perform other duties as assigned and maintain compliance with organizational policies, standards, and regulatory requirements.

Education/Experience:

• Bachelor’s degree in related field or equivalent experience. Master's Degree preferred in Public Health (MOH), Health Administration (MHA) or Business Administration (MBA).

• 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 lev...