Value-Based Provider Engagement Lead

WellCare of Kentucky; Ohio; On-site; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K with company match

Stock purchase plan

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements (remote/hyb

Job summary

Centene is seeking an Provider Engagement Account Executive to develop strategic partnerships with hospital systems, multispecialty groups and large primary care organizations. You will lead value-based care initiatives, act as VBP SME, and deliver data-driven insights to improve provider performance and member outcomes.

The role requires 5+ years in managed care or clinical operations, strong analytical and presentation skills, and a track record of executive-level engagement.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Master's Degree preferred in Public Health (MPH), 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 levels, externally and internally across multi-disciplinary teams.
• Highly proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• 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.

Skills

Executive leadership

HEDIS/Quality measures

Data analysis

Strategic partnerships

Presentation skills

Relationship management

Education

Bachelor’s degree

Master's degree preferred (MPH / MHA / MBA)

Job description

Centene is seeking an Provider Engagement Account Executive to develop strategic partnerships with hospital systems, multispecialty groups and large primary care organizations. You will lead value-based care initiatives, act as VBP SME, and deliver data-driven insights to improve provider performance and member outcomes.

The role requires 5+ years in managed care or clinical operations, strong analytical and presentation skills, and a track record of executive-level engagement.