Fidelis Care - New York

About the Company

Fidelis Care - New York is proud to provide quality, affordable health coverage for more than 2 million members, at all stages of life.

At Fidelis Care - New York, we’re dedicated to serving residents of New York State who need quality, affordable health coverage. Grassroots outreach - from inner-city neighborhoods to the most rural towns - is central to our mission. From provider offices, to schools, churches, food pantries, and community agencies, Fidelis Care - New York works closely with hundreds of partners to reach local residents in need and to be a resource in our community.

Fidelis Care - New York provides coverage through Child Health Plus, Essential Plan, Medicaid, Health and Recovery Plan, Qualified Health Plans, Managed Long Term Care, and Medicare and Dual Advantage Plans.

Interested in joining our staff? Fidelis Care - New York is always looking for passionate and talented individuals. To learn more about career opportunities with Fidelis Care - New York, please visit https://www.fideliscare.org/Join-Our-Team

Listed Jobs

Company Name

Fidelis Care - New York

Job Title

Provider Engagement Account Executive

Job Description

Job Title: Provider Engagement Account Executive Role Summary: Drive strategic partnerships between the health plan and contracted provider networks, championing value‑based care initiatives to improve patient outcomes, cost efficiency, and quality. Engage physicians through regular visits, data‑driven performance feedback, and education on policies, EDI, and VBP tools. Collaborate cross‑functionally with internal stakeholders and external providers to resolve issues, enhance network performance, and support retention. Expactations: - Build and sustain high‑level relationships with physicians and executive teams. - Lead performance improvement plans using analytics and HEDIS/quality metrics. - Resolve provider claim and network issues promptly. - Coach and train external representatives. - Travel locally (≈4 days/week) to conduct in‑person engagements. - Deliver detailed HBR analysis and reports for JOC meetings. Key Responsibilities: - Develop and maintain strategic provider partnerships. - Conduct regular in‑person support visits to discuss metrics and improvement opportunities. - Apply value‑based care models and negotiate performance‑based agreements. - Use data analytics to track provider performance and provide actionable feedback. - Educate providers on referral, claims, and EDI procedures. - Investigate and resolve high‑volume/high‑dollar claim issues. - Create strategic plans to elevate provider performance. - Present HBR analysis and generate reports for Joint Operating Committee. - Serve as lead and coach for external representatives. Required Skills: - Strong relationship‑building and executive‑level communication. - Proficiency in data analytics, HEDIS/quality measures, and value‑based performance (VBP). - Problem‑solving and issue resolution expertise. - Project management and cross‑disciplinary collaboration. - Coaching and training ability. - Knowledge of EDI, web platforms, and provider policies. Required Education & Certifications: - Bachelor’s degree in a related field (Health Administration, Public Health, Business, etc.) or equivalent experience. - Master’s degree preferred (MOH, MHA, MBA). - Minimum 5 years in managed care or medical group experience (provider relations, quality improvement, utilization management, or clinical operations). - Project management experience in a medical group, IPA, or health plan setting. - Familiarity with HEDIS/quality measures, cost, and utilization.

Queens, United states

On site

Mid level

16-02-2026