Role Overview: The Corporate Provider Network Management Account Executive plays a critical role in developing high-performing provider networks that meet state and Centers for Medicare & Medicaid Services (CMS) requirements for new and expanding markets. In this dynamic and fast-paced role, you will identify and recruit key providers, negotiate contracts, and establish trusted partnerships with healthcare professionals and organizations at a rapid pace. You will also contribute to the strategic direction of network development by creating business plans, process flows, and customized solutions that support organizational objectives.
Work Arrangement:
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Remote - Associate can work remotely anywhere in the United States.
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This position requires 50-60% travel.
Responsibilities:
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Identify, contact, and recruit qualified providers to participate in the Plan network across new and existing service areas.
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Negotiate contracts with hospitals, physicians, and ancillary providers.
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Engage with providers at all organizational levels and across diverse system types.
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Maintain consistent communication and follow-up with prospective providers until the enrollment process is complete.
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Submit complete and accurate provider applications to the credentialing department to support timely processing.
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Document and report issues that may impact recruiting efforts.
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Stay current on all Request for Proposal (RFP) and application requirements relevant to network development.
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Maintain clear, accurate records of all provider interactions and activities.
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Support team members by identifying challenges and contributing innovative solutions that enhance processes and expand the use of technology.
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Foster collaborative working relationships and build trust across teams.
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Recommend creative operational approaches to reduce backlogs and improve resource utilization.
Education & Experience:
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Bachelor’s degree in Business, Healthcare Administration, Healthcare Management, or a related field is required
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2 to 3 years of experience in Medicaid, Medicare, Exchange or Commercial Provider Contracting preferred.
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5 to 7 years of progressive business experience in provider network management.
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Strong knowledge of provider network management processes and programs, including Performance Improvement Plans (PIPs), hospital savings initiatives, Accountable Care Organizations (ACOs), and Patient-Centered Medical Homes (PCMH), is strongly preferred.
Licensure:
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Valid driver’s license and car insurance required.
Skills & Abilities:
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Strong understanding of customer and market dynamics and key business drivers.
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Commitment to working collaboratively and strengthening provider networks.
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Strong negotiation, communication, and active listening skills.
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Demonstrated leadership and proven ability to achieve results.
