What are the responsibilities and job description for the Payer Utilization Management Consulting Leader position at Accenture?

Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 750,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song. These capabilities, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships.

As a Payer Utilization Management Consulting Leader, your primary responsibilities may include :

Client Engagement & Strategy Development

Serve as a trusted advisor to clients, understanding their utilization management challenges and designing tailored strategies to enhance efficiency, compliance, and member experience.

Lead client engagements, ensuring high-quality deliverables and satisfaction.

Project Leadership & Delivery

Oversee multiple, complex projects simultaneously, managing cross-functional teams to deliver on time and within budget.

Develop and implement best practices for utilization management, including prior authorization, case management, and appeals processes.

Facilitate workshops, presentations, and working sessions with clients and stakeholders.

Operational Improvement & Technology Enablement

Analyze existing utilization management operations, identify areas for improvement, and recommend data-driven solutions.

Partner with technology teams to implement automation and advanced analytics in utilization management workflows.

Regulatory Compliance and Risk Management

Ensure clients’ enterprise functions comply with healthcare regulations and industry standards, advising on regulatory updates and best practices.

Develop risk management frameworks for clients, supporting them in identifying and mitigating operational, compliance, and financial risks.

Business Development

Identify and pursue new business opportunities, contribute to proposal development, and lead sales presentations.

Build strong relationships with clients and industry stakeholders to expand the firm’s presence in the healthcare payer space.

Team Leadership and Development

Lead and mentor a team of managers, consultants, and analysts, fostering a collaborative and high-performance environment.

Provide professional development opportunities, coaching, and feedback to build a skilled and motivated team aligned with organizational goals.

Thought Leadership and Industry Engagement

Stay current with healthcare industry trends, regulatory changes, and emerging technologies related to payer utilization functions.

Contribute to the firm’s thought leadership through whitepapers, webinars, and industry presentations, positioning the firm as a leader in payer utilization consulting.

Qualifications :

Bachelor's degree in Business Administration, Healthcare Management, Health Policy, or a related field.

Minimum of 5 years of experience in payer utilization management, health administration, healthcare consulting, or payer operations with a focus on utilization management.

Minimum of 5 years of experience in healthcare regulations and accreditation requirements.

Bonus points if you have :

Master's degree preferred.

Experience working with or leading global teams.

Thrive in a diverse, fast paced environment.

An advanced degree in the area of specialization.

Exceptional problem-solving and analytical skills.

Excellent communication and presentation abilities.

Leadership experience executing and achieving specific health utilization and medical cost outcome metrics.

Leadership experience supporting a payer through a CMS ODAG audit.

Proven ability to plan, organize and deliver impactful results across multiple projects or initiatives.

Existing relationships and delivery history with clinical operations leaders of target Accenture Health Industry clients.

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Payer Utilization Management Consulting Leader

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