Remote Healthcare Strategy Consultant: Utilization & Policy

Highmark Health; Helena (MT); Remote; USD 109,000 - 181,000; Full time

Job summary

Highmark Inc. seeks a highly tactical Strategy Consultant to drive change within Utilization Management and Medical Policy operations. You will build data models to prove financial and operational impacts, and translate analytics into actionable business recommendations.

You will lead cross-functional projects, collaborate with data engineering, and develop sprint-ready tactical steps within leadership guidance, focusing on cost-savings and governance for prior authorization processes.

Qualifications

• Masters degree or higher in a healthcare/business field with strategy experience.
• Experience with healthcare strategy, economics or analytics and related data assets.
• Strong data modeling and analytical framework skills for healthcare.

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

Skills

Data manipulation

SQL

Python

R

Power BI

Tableau

Education

Masters Degree in Business, Healthcare, Economics

2 years post-grad strategy/consulting experience

6 years related experience in Business/Healthcare

Bachelor's degree + 3 years experience in lieu of Master

Tools

SQL

Python

R

Power BI

Tableau

Job description

Highmark Inc. seeks a highly tactical Strategy Consultant to drive change within Utilization Management and Medical Policy operations. You will build data models to prove financial and operational impacts, and translate analytics into actionable business recommendations.

You will lead cross-functional projects, collaborate with data engineering, and develop sprint-ready tactical steps within leadership guidance, focusing on cost-savings and governance for prior authorization processes.