Pursue Your Passion with Purpose

Job Title

Work Setup:

Hybrid role with employer-provided remote equipment.

Field travel to provider offices 30%50%.

Primary territory: Queens, NY and The Bronx, NY.

Local travel four days per week is required.

Role Purpose:

Build strategic partnerships with contracted provider networks to improve care quality, cost, and member experience.

Lead provider engagement on value-based care initiatives and performance improvement.

Collaborate internally to develop network management strategies and operational efficiencies.

Core Responsibilities:

Conduct regular in-person provider visits to review performance metrics, discuss care improvement opportunities, and provide real-time support.

Drive value-based care adoption by aligning providers to performance-based agreements and quality goals.

Use data analytics to monitor provider performance and deliver actionable feedback and coaching.

Resolve provider issues related to operations, referrals, claims submission, and high-dollar/high-volume claims.

Educate providers on policies, procedures, EDI, and portal usage to streamline workflows.

Evaluate provider performance, develop improvement plans, and track outcomes.

Prepare and present detailed analyses and reports for Joint Operating Committee meetings.

Serve as a lead for external representatives by coaching and training team members.

Maintain strong relationships with internal stakeholders and external provider leadership, including C?suite contacts.

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

Required Qualifications:

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

35+ years in healthcare within managed care, medical groups, provider relations, quality improvement, utilization management, or clinical operations.

Demonstrated face-to-face experience meeting providers to discuss performance metrics and improvement actions.

Valid driver's license and ability to travel locally four days a week.

Preferred Qualifications:

Master's degree in Public Health, Health Administration, or Business Administration.

Project management experience in a medical group, IPA, or health plan setting.

Experience influencing executive-level stakeholders on performance and growth initiatives.

Strong proficiency with HEDIS and quality measures, cost and utilization analytics, and value-based performance.

Skills And Competencies:

Expert communication and relationship management with providers and cross-functional teams.

Data-driven approach with the ability to synthesize complex issues across multiple organizational levels.

Problem-solving and issue resolution with a focus on operational efficiency and provider satisfaction.

Education and coaching skills to improve provider adoption of policies, tools, and performance goals.

Compensation Notes:

Potential annual bonus targets up to 8% based on company performance goals.