Strategy Consultant - Utilization Management and Medical Policy

About the role

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.

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.

• Collaborate Cross-Functionally

  • 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 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.

• 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.

Essential Responsibilities

• Manage major strategy projects with the help of internal or external strategy consulting resources.

• 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.

Qualifications

• 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

• Preferred:

  • 3–5+ years in healthcare strategy, healthcare economics, clinical analytics, or a related consulting role focused on tactical execution.
  • Highly proficient in data manipulation and modeling (e.g., advanced SQL, Python/R, or complex Power BI/Tableau builds).
  • Deep understanding of healthcare financial and operational datasets (claims, procedure codes, cost-of-care).
  • Working knowledge of Utilization Management, Medical Policy, and clinical terminologies (EHR, ICD-10, interoperability standards).
  • Proven ability to collaborate with highly technical data teams and present compelling, data-backed operational changes to clinical leaders.

Skills

• Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other related fields
• Strong PC application Skills (MS Office including PowerPoint and Excel)
• Knowledge of healthcare industry trends and challenges
• Strong critical thinking skills
• Good communication and presentation skills

Benefits

Not specified

Pay

$108,600.00 - $180,600.00

Schedule

Remote