Medicare Advantage Operations Lead | Remote

Intermountain Healthcare Inc.; Lincoln (NE); À distance; USD 82 000 - 127 000; Plein temps

Résumé du poste

Intermountain Health seeks a Medicare Advantage Operations leader for a fully remote role. You will oversee daily MA program operations, ensuring CMS compliance and alignment with policies while driving efficiency and member satisfaction.

You will collaborate with CMS, Compliance, Legal, Finance, Product Leadership, and Market Presidents to optimize enrollment, product development, claims, utilization management, and care coordination.

Qualifications

• Bachelor’s degree and 5+ direct years of Medicare Advantage experience.
• Experience with CMS audits, STAR ratings optimization, or quality initiatives.
• Background in payer operations, health plans, or value-based care organizations.

Responsabilités

• Lead daily market operations of the Medicare Advantage program per CMS regulations.
• Develop and optimize operations for enrollment, product development, member services, claims, utilization, and care coordination.
• Ensure readiness for CMS audits and annual product development changes.
• Collaborate with Compliance, Legal, and HPMS memos to interpret CMS guidance.
• Drive Star Ratings, member experience, and KPIs with leadership.
• Oversee vendor performance and contract compliance with delegated entities.
• Collaborate with Finance on budgeting and cost management.
• Foster local market accountability and continuous improvement.
• Support growth initiatives including new markets and AEP.
• Use data/reporting to identify trends, risks and opportunities.

Connaissances

Medicare Operations

Leadership

Project Management

Data analytics

Strategic planning

Communication

Analytical skills

Communication skills

Problem Solving

Formation

Bachelor’s degree

Description du poste

Intermountain Health seeks a Medicare Advantage Operations leader for a fully remote role. You will oversee daily MA program operations, ensuring CMS compliance and alignment with policies while driving efficiency and member satisfaction.

You will collaborate with CMS, Compliance, Legal, Finance, Product Leadership, and Market Presidents to optimize enrollment, product development, claims, utilization management, and care coordination.