Strategy Consultant - Utilization Management and Medical Policy

Highmark Inc.

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.

• 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.

• 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

• 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…