Medicare Advantage Operations Lead (Remote)

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

Job summary

Intermountain Health is seeking a senior leader to oversee Medicare Advantage operations, partnering with CMS and market leadership to ensure regulatory alignment, program performance, and member satisfaction. The role drives enrollments, product development, and care coordination across markets.

Responsibilities include audits readiness, vendor management, budgeting, and data-driven improvements to Star Ratings and KPIs, with a focus on growth and efficiency.

Qualifications

• Bachelor’s degree.
• 5+ direct years of Medicare Advantage experience.
• CMS audits, STAR ratings optimization, and/or quality improvement 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 CMS compliance 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

5+ direct years of Medicare Advantage experience

CMS audits, STAR ratings optimization, and/or quality improvement initiatives

Payer operations, health plans, or value-based care

Delegated and vendor management models

Lean, Six Sigma, or process improvement certification

Job description

Intermountain Health is seeking a senior leader to oversee Medicare Advantage operations, partnering with CMS and market leadership to ensure regulatory alignment, program performance, and member satisfaction. The role drives enrollments, product development, and care coordination across markets.

Responsibilities include audits readiness, vendor management, budgeting, and data-driven improvements to Star Ratings and KPIs, with a focus on growth and efficiency.