Medicare Advantage Ops Leader – Remote

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

Job summary

Intermountain Health's Select Health division seeks a Medicare Advantage program leader to oversee operations across enrollment, care coordination, and member services. You will ensure CMS compliance, drive Star Ratings, and partnering with P&L leaders to optimize performance in a fully remote role.

The role collaborates with Compliance, Legal, Finance, and Market Presidents; requires 5+ years MA experience, Bachelor’s, and process improvement skills.

Qualifications

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

Responsibilities

• Lead daily market operations of the Medicare Advantage program ensuring CMS compliance and policy adherence.
• Develop and optimize strategies for enrollment, product development, member services, claims, utilization, and care coordination.
• Ensure readiness for CMS audits, program reviews, and regulatory changes in the product development cycle.
• Interpret CMS guidance with Compliance and Legal and operationalize it across functions.
• Drive Star Ratings, member experience, and KPIs with leadership teams.

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

Payer operations / health plans experience

CMS audits / quality improvement

vendor management models

Lean, Six Sigma or process improvement cert

Job description

Intermountain Health's Select Health division seeks a Medicare Advantage program leader to oversee operations across enrollment, care coordination, and member services. You will ensure CMS compliance, drive Star Ratings, and partnering with P&L leaders to optimize performance in a fully remote role.

The role collaborates with Compliance, Legal, Finance, and Market Presidents; requires 5+ years MA experience, Bachelor’s, and process improvement skills.