Accenture
Health Payer Utilization Consultant/Manager
Accenture, Boston, Massachusetts, us, 02298
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. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song. These capabilities, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. Visit us at
www.accenture.com . 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 firm’s thought leadership through participation in webinars and industry presentations, positioning the firm as a leader in health industry consulting. Qualification 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. 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. What We Believe We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment. Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process.
#J-18808-Ljbffr
www.accenture.com . 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 firm’s thought leadership through participation in webinars and industry presentations, positioning the firm as a leader in health industry consulting. Qualification 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. 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. What We Believe We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment. Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process.
#J-18808-Ljbffr