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*
* +  
** 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.

+  
*
* 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._

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** Healthcare Domain Expertise:
** Deep understanding of healthcare financial and operational datasets (claims, procedure codes, cost-of-care).

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** Clinical Context:
** Working knowledge of Utilization Management, Medical Policy, and clinical terminologies (EHR, ICD-10, interoperability standards).

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** Translation & Communication:
** Proven ability to collaborate with highly technical data teams and present compelling, data-backed operational changes to clinical leaders.

**…