Payer Utilization Management Consulting Manager/Consultant

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As a Payer Utilization Management Consulting Manager/Consultant, your primary responsibilities may include:

• Enterprise Function Integration
  • Support the development and implementation of strategies across payer functions (e.g., operations, clinical, finance, and compliance) to enhance utilization management processes.
  • Conduct assessments of client utilization management structures, identifying areas for improvement and alignment with organizational goals.
• Strategic Program Management
  • Manage cross-functional utilization management projects, ensuring timely execution and adherence to quality standards.
  • Create and maintain project plans, timelines, and resource allocation plans.
  • Identify potential risks and support the development of mitigation strategies.
• Regulatory Compliance and Risk Management
  • Ensure clients utilization management practices adhere to healthcare regulations (e.g., CMS, NCQA, HIPAA).
  • Provide support in implementing risk management frameworks and addressing compliance issues.
• Operational Efficiency and Process Improvement
  • Serve as a key point of contact for client stakeholders, building strong relationships and providing guidance on utilization management initiatives.
  • Collaborate with clients to identify process inefficiencies and recommend improvements to reduce costs and enhance service delivery.
  • Leverage data and analytics to support optimization of prior authorization, case management, and appeals workflows.
• Team Leadership and Development
  • Provide guidance and mentorship to junior team members, fostering their professional growth and supporting project delivery.
  • Support internal initiatives to enhance team capabilities and service offerings.
• Data Analytics and Reporting
  • Assist in developing analytics frameworks and dashboards to track utilization management performance and identify improvement opportunities.
  • Present findings and recommendations to client teams, using data to inform decision-making and operational improvements.
• Thought Leadership and Industry Engagement
  • Stay informed about healthcare industry trends, regulatory updates, and advancements in utilization management technology.
  • Contribute to the firms thought leadership through participation in webinars and industry presentations, positioning the firm as a leader in health industry consulting.

Why should I join the Accenture Health team?

• Innovate every day. Be at the forefront of designing and delivering health technology solutions that push boundaries and create new opportunities for our clients.

• Lead with the industrys best. Join an industry-recognized healthcare leader with more than 20,000 global healthcare professionals collaborating to drive enterprise-wide transformational projects on a global scale. Accenture has worked with more than 200 clients to deliver healthcare transformation to meet the diverse needs of patients and members.

• Learn and grow continuously. Harness unmatched training and professional development to help you build and advance your health, consultative and delivery skills. With learning resources, interactive classroom courses, real-life client simulations and ongoing mentoring available when you need it, youll expand your thinking beyond the core Workday implementation.

Qualification

Heres what you need:

• Bachelor's degree in Business Administration, Healthcare Management, Health Policy, or a related field.
• Minimum of 3 years of experience in payer utilization management, health administration, healthcare consulting, or payer operations with a focus on utilization management.
• Minimum of 3 years of experience in healthcare regulations and accreditation requirements.

Bonus points if you have:

• Master's degree preferred.
• Experience working with or leading global teams.
• Thrive in a diverse, fast paced environment.
• An advanced degree in the area of specialization.
• Exceptional problem-solving and analytical skills.
• Excellent communication and presentation abilities.
• Proven ability to plan, organize, and deliver impactful results across multiple projects or initiatives.
• Proven understanding of utilization management operating models, technology enablers, and regulatory requirements.
• Experience executing and achieving specific health utilization and medical cost outcome metrics.
• Experience supporting a payer through a CMS ODAG audit.

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired in California, Colorado, District of Columbia, Maryland, New York or Washington as set forth below.

We accept applications on an on-going basis and there is no fixed deadline to apply.

Information on benefits is here.

Role Location Annual Salary Range

California $63,200 to $258,500

Colorado $63,200 to $223,300

District of Columbia $67,300 to $237,800

New York $58,500 to $258,500

Maryland $58,500 to $206,800

Washington $67,300 to $237,800

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