Accenture
Health Payer Utilization Consultant/Manager
Accenture, San Francisco, California, United States, 94199
Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 750,000 people serving clients in more than 120 countries.
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. Strategic Program Management:
Manage cross-functional utilization management projects, ensuring timely execution and adherence to quality standards. Regulatory Compliance and Risk Management:
Ensure clients’ utilization management practices adhere to healthcare regulations (e.g., CMS, NCQA, HIPAA). 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. Team Leadership and Development:
Provide guidance and mentorship to junior team members, fostering their professional growth and supporting project delivery. Data Analytics and Reporting:
Assist in developing analytics frameworks and dashboards to track utilization management performance and identify improvement opportunities. Thought Leadership and Industry Engagement:
Stay informed about healthcare industry trends, regulatory updates, and advancements in utilization management technology. Qualifications: Here’s 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. 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. Why should I join the Accenture Health team? Innovate every day. Be at the forefront of designing and delivering health technology solutions. Lead with the industry’s best. Join an industry-recognized healthcare leader. Learn and grow continuously. Harness unmatched training and professional development.
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Support the development and implementation of strategies across payer functions (e.g., operations, clinical, finance, and compliance) to enhance utilization management processes. Strategic Program Management:
Manage cross-functional utilization management projects, ensuring timely execution and adherence to quality standards. Regulatory Compliance and Risk Management:
Ensure clients’ utilization management practices adhere to healthcare regulations (e.g., CMS, NCQA, HIPAA). 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. Team Leadership and Development:
Provide guidance and mentorship to junior team members, fostering their professional growth and supporting project delivery. Data Analytics and Reporting:
Assist in developing analytics frameworks and dashboards to track utilization management performance and identify improvement opportunities. Thought Leadership and Industry Engagement:
Stay informed about healthcare industry trends, regulatory updates, and advancements in utilization management technology. Qualifications: Here’s 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. 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. Why should I join the Accenture Health team? Innovate every day. Be at the forefront of designing and delivering health technology solutions. Lead with the industry’s best. Join an industry-recognized healthcare leader. Learn and grow continuously. Harness unmatched training and professional development.
#J-18808-Ljbffr