Medicare Advantage Program Lead - Remote

Intermountain Healthcare Inc.; Carson City (NV); Remote; USD 82,000 - 127,000; Full time

Job summary

Intermountain Health's Select Health division seeks a Senior Manager for Medicare Advantage operations. You will lead daily market operations, ensure CMS compliance, optimize enrollment, claims, utilization management, and care coordination, and drive STAR ratings and KPIs with senior leadership.

The role supports multiple markets with remote work options and regular collaboration with Compliance, Legal, Finance, and Product teams to deliver compliant, high-quality member experiences.

Qualifications

• Bachelor’s degree required and 5+ years direct Medicare Advantage experience.
• Experience with CMS audits, STAR ratings optimization, 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 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

5+ direct years of Medicare Advantage experience

CMS audits, STAR ratings optimization, and 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

Job description

Intermountain Health's Select Health division seeks a Senior Manager for Medicare Advantage operations. You will lead daily market operations, ensure CMS compliance, optimize enrollment, claims, utilization management, and care coordination, and drive STAR ratings and KPIs with senior leadership.

The role supports multiple markets with remote work options and regular collaboration with Compliance, Legal, Finance, and Product teams to deliver compliant, high-quality member experiences.