Medicare Advantage Operations Lead – Remote

Intermountain Healthcare Inc.; Denver (CO); Remote; USD 82,000 - 127,000; Full time

Benefits offered by this job

Generous benefits package

Remote work option

AP4P pay-for-performance program

Job summary

Intermountain Health, including Select Health operations, seeks a senior leader to manage Medicare Advantage programs across multiple markets. You will partner with CMS-regulatory teams, P&L leadership, and market Presidents to ensure compliant, efficient operations and strong member outcomes.

Responsibilities include running daily MA operations, improving enrollment processes, coordinating with compliance, finance, and vendor management, and driving star ratings and quality measures.

Qualifications

• Bachelor’s degree required.
• 5+ direct years of Medicare Advantage experience.
• Experience with CMS audits, STAR ratings optimization, and quality initiatives.
• Background in payer operations, health plans, or value-based care organizations.
• Knowledge of delegated and vendor management models.
• Lean, Six Sigma, or other process improvement certification.

Responsibilities

• Lead and oversee daily market operations of the Medicare Advantage program, ensuring compliance with CMS regulations and internal policies.
• Develop, implement, and optimize operational strategies to support enrollment, product development, member services, claims, utilization management, and care coordination.
• Ensure operational readiness for CMS audits, program reviews, and regulatory changes as it relates to the annual product development cycle.
• Partner with Compliance and Legal teams to interpret and operationalize CMS guidance, HPMS memos, and federal/state regulations.
• Drive performance improvements related to Star Ratings, member experience, quality measures, and operational KPIs with Market Presidents, Product Leadership, and Medicare P & L leadership.
• With compliance, support oversight and delegated entity performance, vendor performance, including contract compliance and reporting.
• Collaborate with Finance on budgeting, forecasting, and cost management related to MA operations.
• Foster local market accountability and continuous improvement.
• Support growth initiatives, including new market entry, benefit design changes, and annual enrollment periods (AEP).
• Leverage data and reporting to identify trends, risks, and opportunities for operational enhancement.

Skills

Medicare Operations

Leadership

Project Management

Data analytics

Strategic planning

Communication

Analytical skills

Communication skills

Problem Solving

Education

Bachelor’s degree

Job description

Intermountain Health, including Select Health operations, seeks a senior leader to manage Medicare Advantage programs across multiple markets. You will partner with CMS-regulatory teams, P&L leadership, and market Presidents to ensure compliant, efficient operations and strong member outcomes.

Responsibilities include running daily MA operations, improving enrollment processes, coordinating with compliance, finance, and vendor management, and driving star ratings and quality measures.