Lead the strategic alignment between health plans and provider networks to enhance performance, quality outcomes, and cost efficiency. This position acts as the primary liaison for providers, ensuring clear communication, accountability, and resolution of operational and financial concerns.
What You'll Do
Build and maintain strong partnerships with provider networks to identify opportunities for improvement in performance, claims processing, and care delivery. Guide providers in understanding policies related to referrals, claims submission, electronic data interchange (EDI), and digital tools. Deliver ongoing education through orientations and training sessions, and develop materials that support provider success.
Monitor and analyze provider performance using key metrics including Health Benefit Ratio (HBR), HEDIS, risk adjustment, and utilization trends. Prepare detailed reports for leadership committees and support the implementation of performance improvement strategies. Use value-based performance (VBP) tools to coach providers on data interpretation and performance tracking. Support new team members by sharing expertise and guiding best practices in provider engagement.
Requirements
A bachelor’s degree in a relevant field or equivalent professional experience is required. Candidates must have at least three years of experience in managed care, medical groups, provider relations, quality improvement, claims, contracting, or clinical operations. Prior project management experience within a health plan, IPA, or medical group setting is essential. Proficiency in HEDIS, cost and utilization analysis, and strong presentation skills are necessary. Applicants must be authorized to work in the U.S. without current or future visa sponsorship.
Benefits
- Competitive salary range of $70,100–$126,200 per year
- Comprehensive health insurance
- 401(k) with company match
- Stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible work arrangements including remote, hybrid, and field-based options
Work Mode
This role requires local presence with regular field travel—four days per week on average. Candidates must reside in New York, specifically in Nassau, Suffolk, Queens, Brooklyn, Manhattan, Bronx, Buffalo, Westchester, or nearby surrounding areas. Work flexibility includes hybrid and remote options based on operational needs.
