Medicare Advantage Program Lead (Remote)

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

Job summary

Intermountain Health seeks a senior leader to manage Medicare Advantage programs, ensuring CMS regulatory compliance and end-to-end operational performance. You will partner with P&L leadership, Product Leadership, and Market Presidents to optimize enrollment, care coordination, and quality outcomes.

The role emphasizes operational excellence, annual product development cycles, and vendor/contract oversight, with remote work options and potential travel. Strong Medicare MA experience is required.

Qualifications

• Lead and oversee Medicare Advantage operations.
• Ensure CMS compliance and internal policies.
• Develop and optimize operational strategies for enrollment, product development, and member services.
• Prepare for CMS audits, program reviews, and regulatory changes.
• Drive Star Ratings, member experience, and KPI improvements.

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

Job description

Intermountain Health seeks a senior leader to manage Medicare Advantage programs, ensuring CMS regulatory compliance and end-to-end operational performance. You will partner with P&L leadership, Product Leadership, and Market Presidents to optimize enrollment, care coordination, and quality outcomes.

The role emphasizes operational excellence, annual product development cycles, and vendor/contract oversight, with remote work options and potential travel. Strong Medicare MA experience is required.