Payer Utilization Management Consulting Leader

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.

Strategy & Consulting: We work with C-suite executives, leaders and boards of the world’s leading organizations, helping them reinvent every part of their enterprise to drive greater growth, enhance competitiveness, implement operational improvements, reduce cost, deliver sustainable 360° stakeholder value, and set a new performance frontier for themselves and the industry in which they operate. Our deep industry and functional expertise is supported by proprietary assets and solutions that help organizations transform faster and become more resilient. Underpinned by technology, data, analytics, AI, change management, talent and sustainability capabilities, our Strategy & Consulting services help architect and accelerate all aspects of an organization’s total enterprise reinvention.

As a Payer Utilization Management Consulting Leader, your primary responsibilities may include:

+ Client Engagement & Strategy Development

+ Serve as a trusted advisor to clients, understanding their utilization management challenges and designing tailored strategies to enhance efficiency, compliance, and member experience.

+ Lead client engagements, ensuring high-quality deliverables and satisfaction.

+ Project Leadership & Delivery

+ Oversee multiple, complex projects simultaneously, managing cross-functional teams to deliver on time and within budget.

+ Develop and implement best practices for utilization management, including prior authorization, case management, and appeals processes.

+ Facilitate workshops, presentations, and working sessions with clients and stakeholders.

+ Operational Improvement & Technology Enablement

+ Analyze existing utilization management operations, identify areas for improvement, and recommend data-driven solutions.

+ Partner with technology teams to implement automation and advanced analytics in utilization management workflows.

+ Regulatory Compliance and Risk Management

+ Ensure clients’ enterprise functions comply with healthcare regulations and industry standards, advising on regulatory updates and best practices.

+ Develop risk management frameworks for clients, supporting them in identifying and mitigating operational, compliance, and financial risks.

+ Business Development

+ Identify and pursue new business opportunities, contribute to proposal development, and lead sales presentations.

+ Build strong relationships with clients and industry stakeholders to expand the firm’s presence in the healthcare payer space.

+ Team Leadership and Development

+ Lead and mentor a team of managers, consultants, and analysts, fostering a collaborative and high-performance environment.

+ Provide professional development opportunities, coaching, and feedback to build a skilled and motivated team aligned with organizational goals.

+ Thought Leadership and Industry Engagement

+ Stay current with healthcare industry trends, regulatory changes, and emerging technologies related to payer utilization functions.

+ Contribute to the firm’s thought leadership through whitepapers, webinars, and industry presentations, positioning the firm as a leader in payer utilization 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 industry’s 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, you’ll expand your thinking beyond the core Workday implementation.

Qualification

Here’s what you need:

+ Bachelor's degree in Business Administration, Healthcare Management, Health Policy, or a related field.

+ Minimum of 5 years of experience in payer utilization management, health administration, healthcare consulting, or payer operations with a focus on utilization management.

+ Minimum of 5 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.

+ Leadership experience executing and achieving specific health utilization and medical cost outcome metrics.

+ Leadership experience supporting a payer through a CMS ODAG audit.

+ Proven ability to plan, organize and deliver impactful results across multiple projects or initiatives.

+ Existing relationships and delivery history with clinical operations leaders of target Accenture Health Industry clients.

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. (https://www.accenture.com/us-en/careers/local/total-rewards)

Role Location Annual Salary Range

California $93,400 to $336,900

Colorado $93,400 to $291,100

District of Columbia $99,500 to $309,900

New York $86,500 to $336,900

Maryland $86,500 to $269,500

Washington $99,500 to $309,900

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