Medicare Advantage Health Services Lead

xHealth Management, LLC; Sperry (OK); On-site; USD 90,000 - 120,000; Full time

Job summary

xHealth Management, LLC in Tulsa, OK seeks a Health Services Manager to lead a small Medicare Advantage plan’s clinical and operational functions, oversee utilization management, care management, and quality improvement, and provide oversight of appeals and grievances.

The role partners with the Medical Director, Compliance, and Member Services to ensure regulatory compliance, timely decision-making, audit readiness, and member-centred care across end-to-end processes.

Qualifications

• RN licensed in Oklahoma.
• Experience with Medicare Advantage programs and regulatory requirements.
• Proven ability to lead cross-functional teams in a small, regulated environment.

Responsibilities

• Serve as cross-functional clinical and operational lead for a small Medicare Advantage plan.
• Oversee utilization management activities per CMS requirements.
• Develop and lead care management and transitions of care for high-risk members.
• Manage end-to-end appeals, grievances, and complaints processes.
• Provide oversight to Medical Director and coordinate clinical review workflows.
• Partner with Compliance and operations to maintain audit readiness and continuous improvement.

Skills

Cross-functional leadership

Regulatory compliance

CMS regulations

Quality improvement

Communication

Team collaboration

Education

RN license in Oklahoma

Job description

xHealth Management, LLC in Tulsa, OK seeks a Health Services Manager to lead a small Medicare Advantage plan’s clinical and operational functions, oversee utilization management, care management, and quality improvement, and provide oversight of appeals and grievances.

The role partners with the Medical Director, Compliance, and Member Services to ensure regulatory compliance, timely decision-making, audit readiness, and member-centred care across end-to-end processes.