Responsible for clinical leadership and oversight of health management processes and teams to ensure quality outcomes and effective use of resources. Works in conjunction and collaboration with operational leadership and Senior Physician/Medical Director to understand clinical trends, engage with clients and prospects to align on clinical success criteria and implement operational controls to achieve criteria/targets.

Responsible for supporting leadership and operational teams with process and performance improvement initiatives from concept to implementation. Develop and manage clinical programs that maintain the utilization of best practices and emphasize timely, appropriate, cost-effective care. Scope of responsibilities include health management services such as Utilization Management (UM), Care Management, and other integrated care functions such as Discharge Planning and Care Management program to promote a coordinated, interdisciplinary process in the continuum of care.

Key Responsibilities:

+ Brings subject matter knowledge, clinical leadership and management experience to clinical operation teams relying on experience and judgment to plan and accomplish goals/achieve desired outcomes.

+ Oversees clinical quality and training programs across all health management clients which includes program design, development and implementation.

+ Directs the clinical management leads, quality, training, regulatory compliance, and accreditation staff.

+ Oversees team responsible for monitoring ongoing compliance with state and federal requirements for the UM department, supports business with completing business impact assessment(s) and implements actions to correct issues, improve and maintain compliance.

+ Responsible for setting up and maintaining Clinical Operations that comply with applicable regulation and accreditation requirements for existing and new clients.Develops relationship with the client and serves as a point of contact for escalated clinical issues.

+ Consults with and/or refers clinical issues to the Senior Physician/Medical Director/Client’s Clinical Leadership as needed and appropriate.

+ Provides support to attain and maintain accreditation from URAC, NCQA or other applicable accrediting bodies.

+ Collaborates with quality and operations to review trends, identify root cause, and implement quality improvement initiatives to address trends and opportunities.

+ Develops resource tools and conducts training to educate the clinical and administrative staff in the many aspects of clinical, delegated functions and operational policies and procedures at least annually to ensure staff competence.

+ Evaluates effectiveness of clinical training programs and facilitates corrective action as appropriate.

+ Serves as point of contact for designing and developing new client delivery capabilities and clinical programs/workflows.

+ Supports the organizational objective to have qualified clinicians that are accountable to the organization for decisions affecting health care consumers.

+ Manages clinical resources, including but not limited to overall staffing, performance management, succession planning, resource optimization, and time allocation.

+ Collaborates with Client’s clinical leadership team to improve efficiency and effectiveness of services, and to identify solutions to identified issues or escalations.

+ Maintains business and industry knowledge to guide customers with strategic delivery decisions.

+ Participates in strategic planning for existing and expanding business includes setting growth objectives, contributing to strategy, building internal and client relationships, and supporting sales pursuits including RFP responses/presentations, client meetings, and site visits.

+ Actively participates during sales presentations and provides subject matter expertise for clinical-related issues.

Job Requirements:

+ This role will require travel approximately 20% of the time to include international travel

Basic Qualifications:

+ US RN License in good standing to practice

+ Minimum of 10 years of Utilization Management experience (ex. prior authorization, concurrent review, and or medical necessity appeals)

+ Minimum of 7 years of experience managing a clinical team

+ Minimum of 5 years of case management experience

+ Minimum of 5 years of clinical experience

Preferred Qualifications:

+ Experience in quality auditing and reporting in a health plan environment proficient to expert

+ URAC and or NCQA Accreditation experience, including direct interfacing with the accrediting bodies proficient to expert

+ Proficiency in InterQual and MCG Criteria.

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, Illinois, Maryland, Minnesota, New York or Washington as set forth below.The application window for this job will remain open until at least 02/24/2025. However, if this date has passed and this role is still posted, please note we are still accepting applications.

Information on benefits is here. (https://www.accenture.com/us-en/careers/local/total-rewards)

Role Location Annual Salary Range

California $163,000 to $413,600

Colorado $163,000 to $357,400

District of Columbia $173,500 to $380,500

Illinois $150,900 to $357,400

Minnesota $163,000 to $357,400

Maryland $150,900 to $330,900

New York $150,900 to $413,600

Washington $173,500 to $380,500

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. Read more here (https://www.accenture.com/us-en/about/inclusion-diversity/us-workforce)

Equal Employment Opportunity Statement

Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

Accenture is committed to providing veteran employment opportunities to our service men and women.

For details, view a copy of the Accenture Equal Employment Opportunity and Affirmative Action Policy Statement (https://www.accenture.com/content/dam/accenture/final/accenture-com/docu...) .

Requesting An Accommodation

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. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email (https://www.accenture.com/us-en/about/contact-us) or speak with your recruiter.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.