Medicare Advantage Program Lead (Remote)

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

Job summary

Intermountain Health in Murray, Utah, is seeking a Senior Manager for Medicare Advantage operations. You will lead daily market operations, ensure CMS compliance, and partner with CMS, Product Leadership, and Market Presidents to drive performance, enrollment, and member satisfaction.

This remote-enabled role emphasizes regulatory readiness, data-driven improvement, and collaboration with Compliance, Legal, Finance, and vendors.

Qualifications

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

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 in Murray, Utah, is seeking a Senior Manager for Medicare Advantage operations. You will lead daily market operations, ensure CMS compliance, and partner with CMS, Product Leadership, and Market Presidents to drive performance, enrollment, and member satisfaction.

This remote-enabled role emphasizes regulatory readiness, data-driven improvement, and collaboration with Compliance, Legal, Finance, and vendors.