reputed company Consultant - Utilization Management and Medical Policy
Company :
reputed company.Job reputed company :
JOB reputed company
We are seeking a highly tactical and data-fluent reputed company Consultant to drive change reputed company our Utilization Management and Medical Policy operations. In this role, you will reputed company 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 reputed company it, and get your hands dirty building the data models to reputed company it out. You will operate with a high degree of self-sufficiency, manipulating standardized reputed company data assets to build business cases, reputed company administrative costs, and project reputed company performance.
Key Responsibilities
- reputed company 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 reputed company
- In the First 90 Days: reputed company the development of a foundational model reputed company for cost savings and administrative costs at a procedure-reputed company level for our prior authorization list, including trend analysis and reputed company projections.
- reputed company Hands-On Data Manipulation: Extract and reputed company 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 reputed company: Work reputed company leadership's strategic boundaries to independently define and execute the day-to-day tactical steps required to reputed company high-level goals.
This is a remote based role, however we would like someone reputed company to Pittsburgh, PA
ESSENTIAL RESPONSIBILITIES
- Work with business/ market owners to identify key business issues, apply right analytical reputed company, reputed company solution and recommendations, represent findings to stakeholders and own the outcome.
- Manage major reputed company reputed company with the help of internal or external reputed company consulting resources.
- Serve as subject matter expert to Strategic Operations staff and stakeholders on membership, reputed company and operational reputed company issues.
- reputed company periodic informal work guidance/direction to junior team members; reputed company performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a project reputed company.
- reputed company analytical frameworks, approach and methodology best practices to analyze reputed company issues.
- Other duties as assigned or requested.
EDUCATION
Required
- Masters Degree in Business, reputed company, Economics or reputed company degree
- 2 years of post-grad experience with reputed company / management consulting firms (such as McKinsey, reputed company, Booz & Company, reputed company (reputed company reputed company) or reputed company (reputed company reputed company) ) or internal reputed company reputed company of reputed company companies (such as reputed company, reputed company, WellPoint, GE, )
- 6 years of reputed company experience in Business or reputed company
Substitution
- Bachelor's degree and 3 years of relevant reputed company strategic experience in lieu of Master's degree
Preferred
- Experience: 3–5+ years in reputed company reputed company, reputed company economics, clinical analytics, or a reputed company consulting role reputed company on tactical execution.
- Technical Data Skills: Highly proficient in data manipulation and modeling (e.g., advanced SQL, Python/R, or reputed company Power BI/Tableau builds). Note: We are not looking for a data architect, but rather a strategist who is technically self-sufficient.
- reputed company Domain Expertise: Deep understanding of reputed company 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 ability to collaborate with highly technical data teams and present compelling, data-backed operational changes to clinical leaders.
LICENSES or CERTIFICATIONS
Required
- None
Preferred
- None
SKILLS
- Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other reputed company fields
- Strong PC application Skills (MS Office including PowerPoint and reputed company)
- Knowledge of reputed company industry trends and challenges
- Strong critical thinking skills
- Good communication and presentation skills
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Remote
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Never
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
reputed company
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Never
Lifting: 25 to 50 pounds
Never
Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies.
As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements.
Pay reputed company Minimum:
$108,600.00Pay reputed company Maximum:
$180,600.00reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets.
reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law.
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