Strategy Consultant - Utilization Management and Medical Policy
Company :
Highmark Inc. Job Description :
JOB SUMMARY
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.
Key Responsibilities
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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
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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.
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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.
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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.
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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.
This is a remote based role, however we would like someone close to Pittsburgh, PA
ESSENTIAL RESPONSIBILITIES
- 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.
EDUCATION
Required
- 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
Substitution
- Bachelor's degree and 3 years of relevant progressive strategic experience in lieu of Master's degree
Preferred
- Experience: 3–5+ years in healthcare strategy, healthcare economics, clinical analytics, or a related consulting role focused on tactical execution.
- Technical Data Skills: 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.
- Healthcare Domain Expertise: Deep understanding of healthcare financial and operational datasets (claims, procedure codes, cost-of-care).
- Clinical Context: Working knowledge of Utilization Management, Medical Policy, and clinical terminologies (EHR, ICD-10, interoperability standards).
- Translation & Communication: Proven abili