Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Combining unmatched experience and specialized skills across more than 40 industries and all business functions - underpinned by the world's largest delivery network - Accenture works at the intersection of business and technology to help clients improve their performance and create sustainable value for their stakeholders. With approximately 469,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives.
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People in our Client Delivery & Operations career track drive delivery and capability excellence through the design, development and/or delivery of a solution, service, capability or offering. They grow into delivery-focused roles, and can progress within their current role, laterally or upward.
- Provides leadership, guidance, and direction for clinical and non-clinical utilization management and care management activities and decisions across all teams and sites, including but not limited to delivery, compliance, quality, and training
- Oversees performance for all program metrics, including but not limited to performance, quality improvement, cost of care, provider, member and client satisfaction, and staffing
- Oversees analysis of medical management and quality data to identify opportunities for improvement and provides input including but not limited to the design, implementation and evaluation of corrective action plans to improve performance
- Assists staff in the interpretation of medical policy
- Approves client's clinical criteria
- Performs role in accordance with Utilization Management Program, Compliance Program, and Quality Committee Charter requirements
- Provides input and or recommends resources references i.e., reputable clinical websites and published articles for clinical training
- Chairs Quality Committees
- Provides guidance on quality management priorities and projects
- Oversees and supports URAC accreditation activities