Medicare Advantage Operations Leader (Remote)

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

Résumé du poste

Intermountain Health through Select Health seeks a Medicare Advantage program leader to oversee operations across enrollment, care coordination, and member services. You will ensure CMS compliance and drive efficiency and quality in the MA line of business.

The role partners with P&L leadership, Compliance, Product, and Market Presidents to optimize performance, manage vendor relationships, and support annual enrollment through data-driven strategies and governance.

Qualifications

• Bachelor’s degree in a related field.
• 5+ direct years of Medicare Advantage experience.
• Experience with CMS audits, STAR ratings, or quality initiatives.
• Background in payer operations or value-based care.
• Knowledge of delegated/vendor management models.
• Lean, Six Sigma, or similar process improvement certification.

Responsabilités

• 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

Connaissances

Medicare Operations

Leadership

Project Management

Data analytics

Strategic planning

Communication

Analytical thinking

Problem Solving

Formation

Bachelor’s degree

5+ direct years of Medicare Advantage experience

CMS audits / STAR ratings experience

Payer operations / health plan experience

Lean Six Sigma or process improvement certification

Description du poste

Intermountain Health through Select Health seeks a Medicare Advantage program leader to oversee operations across enrollment, care coordination, and member services. You will ensure CMS compliance and drive efficiency and quality in the MA line of business.

The role partners with P&L leadership, Compliance, Product, and Market Presidents to optimize performance, manage vendor relationships, and support annual enrollment through data-driven strategies and governance.