Strategy Consultant - Utilization Management and Medical Policy

Highmark Health • PA, Working at Home - Pennsylvania, NV

29d • $108,600 - $180,600 • Remote

About The Position

We are seeking a highly tactical and data-fluent Strategy Consultant to drive change within our Utilization Management and Medical Policy operations. In this role, you will bridge the gap between clinical decision-making and operational finance. You are a "doer" who can take a defined strategic goal, determine the tactical steps to achieve it, and get your hands dirty building the data models to prove it out. You will operate with a high degree of self-sufficiency, manipulating standardized healthcare data assets to build business cases, track administrative costs, and project future performance.

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
• Bachelor's degree and 3 years of relevant progressive strategic experience in lieu of Master's degree
• Highly proficient in data manipulation and modeling (e.g., advanced SQL, Python/R, or complex Power BI/Tableau builds). Note: We are not looking for a data architect, but rather a strategist who is technically self-sufficient.
• 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).
• Proven ability to collaborate with highly technical data teams and present compelling, data-backed operational changes to clinical leaders.
• Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other related fields
• Strong PC application Skills (MS Office including PowerPoint and Excel)
• Knowledge of healthcare industry trends and challenges
• Strong critical thinking skills
• Good communication and presentation skills

Nice To Haves

• 3–5+ years in healthcare strategy, healthcare economics, clinical analytics, or a related consulting role focused on tactical execution.

Responsibilities

• Develop Financial & Operational Models: Build and implement robust data models to evaluate medical policy and utilization management strategies, quantify financial and operational impacts, and measure actual performance against expected outcomes
• In the First 90 Days: Lead the development of a foundational model accounting for cost savings and administrative costs at a procedure-code level for our prior authorization list, including trend analysis and future projections.
• Perform Hands-On Data Manipulation: Extract and transform data from centralized IT/data offerings to create a fit-for-purpose data layer conducive to analyses.
• Cross-Functional Collaboration: Partner with data engineering teams to secure necessary data assets, and translate those technical assets into actionable insights for clinical and operational stakeholders.
• Execute Tactical Strategy: Work within leadership's strategic boundaries to independently define and execute the day-to-day tactical steps required to achieve high-level goals.
• Work with business/ market owners to identify key business issues, apply right analytical framework, develop solution and recommendations, represent findings to stakeholders and own the outcome.
• Manage major strategy projects with the help of internal or external strategy consulting resources.
• Serve as subject matter expert to Strategic Operations staff and stakeholders on membership, growth and operational strategy issues.
• Provide periodic informal work guidance/direction to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a project basis.
• Develop analytical frameworks, approach and methodology best practices to analyze strategy issues.
• Other duties as assigned or requested.

Benefits

• Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level