Remote Utilization Review Jobs in Foley, AL (NOW HIRING)

Network Performance/Utilization Manager

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 791,000 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. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, 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. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities.

Visit us at www.accenture.com

Role Summary: Advise clients on network strategy, utilization performance, and provider market challenges across Medicaid, rural, and financially pressured environments. The successful candidate will combine deep domain expertise with strong consulting judgment and will be expected to manage teams, advise senior clients, and deliver complex engagements in network strategy, utilization, and provider performance. This individual will build trusted client relationships and help clients improve network performance, access, and provider sustainability in line with their strategic priorities.

As a Network Performance/Utilization Manager, your primary responsibilities may include:

• Advise clients on network strategy, provider capacity, utilization trends, access challenges, and market performance.
• Advise clients on evaluating leakage, referral patterns, service distribution, network adequacy, and provider sustainability.
• Develop strategic recommendations to improve network design, access, utilization management, provider alignment, and value-based outcomes.
• Translate claims, encounter, provider, and market data into clear insights, strategic options, and executive decision materials.
• Manage day-to-day engagement delivery, including workplans, team coordination, deliverable quality, and client communications.
• Work across reimbursement, analytics, policy, and provider strategy teams to solve complex market and performance challenges.
• Build trusted relationships with client stakeholders and help grow the practice's network performance and utilization work.
• Travel: As required, up to 80%

Why should I join the Accenture Health team?

• Innovate every day. Be at the forefront of designing and delivering health technology solutions that push boundaries and create new opportunities for our clients.
• Lead with the industry's best. Join an industry-recognized healthcare leader with more than 20,000 global healthcare professionals collaborating to drive enterprise-wide transformational projects on a global scale. Accenture has worked with more than 200 clients to deliver healthcare transformation to meet the diverse needs of patients and members.
• Learn and grow continuously. Harness unmatched training and professional development to help you build and advance your health, consultative and delivery skills. With learning resources, interactive classroom courses, real-life client simulations and ongoing mentoring available when you need it, you'll expand your thinking beyond the core Workday implementation.

Qualification

Here's what you need:

• Minimum of 5 years of experience in network strategy, utilization analytics, provider economics, or healthcare market analysis.
• Minimum of 2 years of experience assessing hospitals, rural providers, FQHCs, specialty providers, and community-based providers in Medicaid-heavy or financially distressed environments.
• Minimum of 2 years of experience turning claims, encounter, provider, and market data into strategic recommendations.
• Bachelor's Degree

Bonus points if you have:

• Familiarity with provider directory and network data management, data quality, and encounter completeness.
• Strong understanding of provider capacity, leakage, referral patterns, utilization drivers, access, and network adequacy.
• Ability to connect utilization performance to reimbursement, provider sustainability, and VBC outcomes.
• Experience building provider performance scorecards (utilization, quality, access, equity, financial impact).
• Understanding of service line strategy and site-of-care optimization (ASC vs HOPD, home-based care, telehealth).