Senior Account Executive

Role Overview: The primary responsibility of Account Executive Sr. is to develop strong relationships with providers to drive for performance specifically as it relates to core providers who are on risk-based or cost sharing VBC arrangements as well as large health system contracts.

Work Arrangement:

- Remote – This position is fully remote. The Associate must visit provider offices and attend in-person meetings at our Delaware (DE) office.

Responsibilities:

- Supports network development and network management strategies. - Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. - Responsible for participating and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE’s. - Responsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems. - Responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers; including those that are most complex. - Resolve Provider disputes in a timely and compliant manner. - Responsibility for a higher number of multiple practice locations and multi-specialty practices and multiple providers. Should also include hospital systems, contracted subcontractors (DME, Vision, etc.), and ancillary providers. - Develop/implement/manage programs and projects that support/impact high dollar and high member provider groups. - Perform site visits as needed. - Oversee resolution of provider issues managed by other Provider Network support teams. - Take corrective actions required up to and including termination, following Plan policies and procedures. - Operationalizes completed contracts with advanced complexity. - Consults on VBC contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement. - Responsible to maintain and manage Value-Based contract requirements, including but not limited to; monitoring performance standards against VBC or State program requirements, working with key stakeholders and provide oversight on applicable data-sharing or report requirements. - Responsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems. - General Operational Knowledge related to provider satisfaction, education, and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc. - Support contracting for multiple product lines, including LTSS, Exchange, DSNP adequacy gaps (high complexity). - Assist with recruiting providers based on identified network adequacy gaps (high complexity). - Support of VBC negotiations; lead in VBC relationships; may lead negotiations.

Education & Experience:

- Associate’s degree - Bachelor's degree preferred - 7 years of experience if no bachelor's degree. - 5 or more years strong communication skills, financial acumen. - Ability to have difficult conversations.

Licensure:

- Valid driver's license, care insurance, and reliable transportation.