Strategy Consultant – Utilization Management, Medical Policy

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🔥 27 minutes ago

⚜️ Louisiana, North Carolina, +3 more states – Remote

⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🔔 Pennsylvania – Remote ☕ Washington – Remote

💵 $108.6k - $180.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Strategy

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Drive change within our Utilization Management and Medical Policy operations • Bridge the gap between clinical decision-making and operational finance • Build and implement robust data models to evaluate medical policy and utilization management strategies • Lead the development of a foundational model accounting for cost savings and administrative costs • Extract and transform data from centralized IT/data offerings • Partner with data engineering teams to secure necessary data assets • Work within leadership's strategic boundaries to independently define and execute tactical steps

🎯 Requirements

• Masters Degree in Business, Healthcare, Economics or related degree • 2 years of post-grad experience with strategy / management consulting firms (such as McKinsey, Boston Consulting Group, Booz & Company, Accenture (strategy Practice) or Deloitte (Strategy practice) ) or internal strategy groups of healthcare companies (such as Aetna, United Health Group, WellPoint, GE, ) • 6 years of related experience in Business or Healthcare • 3–5+ years in healthcare strategy, healthcare economics, clinical analytics, or a related consulting role focused on tactical execution • Highly proficient in data manipulation and modeling (e.g., advanced SQL, Python/R, or complex Power BI/Tableau builds) • Deep understanding of healthcare financial and operational datasets (claims, procedure codes, cost-of-care) • Working knowledge of Utilization Management, Medical Policy, and clinical terminologies (EHR, ICD-10, interoperability standards)

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Professional development opportunities