Medicare Market Operations Partner

61000 SelectHealth Inc; Murray (KY); À distance; USD 83 000 - 127 000; Plein temps

Résumé du poste

Intermountain Health’s Select Health in Murray seeks a Medicare Market Operations Partner to lead end-to-end MA program operations, ensuring CMS compliance and driving efficiency and member satisfaction.

You will collaborate with P&L leadership, Product leadership, and Market Presidents to implement strategies across enrollment, care coordination, and utilization management, while ensuring readiness for CMS audits and regulatory changes.

Qualifications

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

Responsabilités

• Lead and oversee daily market operations of the Medicare Advantage program, ensuring CMS compliance with regulations.
• Develop, implement, and optimize operational strategies for enrollment, product development, member services, claims, utilization management, and care coordination.
• Ensure operational readiness for CMS audits, program reviews, and regulatory changes during the annual product development cycle.
• Partner with Compliance and Legal teams to interpret CMS guidance, HPMS memos, and federal/state regulations.
• Drive performance improvements related to Star Ratings, member experience, quality measures, and KPIs with Market Presidents and leadership.
• Oversee vendor performance and contract compliance and reporting.
• Collaborate with Finance on budgeting, forecasting, and cost management.
• Foster local market accountability and continuous improvement.
• Support growth initiatives including new market entry and annual enrollment periods (AEP).
• Leverage data and reporting to identify trends, risks, and opportunities for operational enhancement.

Connaissances

Medicare Advantage

CMS audits

Star Ratings

Payer operations

Stakeholder management

Process improvement

Formation

Bachelor's degree

Master's degree (MBA, MHA, MPH)

Description du poste

Job Description: The Medicare Market Operations Partner is responsible to partner with the Medicare P&L leadership, Product Leadership, and Market Presidents to ensure the end‑to‑end operational performance of the organization’s Medicare Advantage line of business. This role ensures operational excellence, regulatory compliance, and alignment with CMS requirements while driving efficiency, quality outcomes, and member satisfaction. The Director partners cross‑functionally with clinical, finance, compliance, network, and technology teams to support profitable growth, Stars performance, and financial sustainability. This individual will interface directly with all key stakeholders as they drive forward a strategic operating plan for each market.

Job Essentials

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

Minimum Qualifications

• Bachelor’s degree
• 5+ direct years of Medicare Advantage experience
• Relevant experience such as working with CMS audits, STAR ratings optimization, and/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

Preferred Qualifications

• Master’s degree (MBA, MHA, MPH, or similar)
• Additional experience in data analytics, strategic planning, communication, analytical skills, problem solving

Additional Information

This is an exempt, full‑time position. Pay offers are determined by prior years of relevant experience within the established pay range. With this position, you are eligible to participate in the Annual Pay for Performance (AP4P) Plan. This plan enables Intermountain Health to provide leaders with an additional performance compensation opportunity. This position can be performed remotely with business travel as‑needed. Intermountain Health maintains employment registration in Utah, Idaho, Nevada, Colorado, Montana, and Wyoming. Candidates in other locations may be considered. Currently, we are not hiring remote workers in the following states: CA, CT, HI, IL, MA, MN, NY, PA, RI, VT, and WA. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings.

We care about your well‑being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Physical Requirements Interact with others requiring the employee to communicate information. Operate computers and other office equipment requiring the ability to move fingers and hands. See and read computer monitors and documents. Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location: SelectHealth - Murray Work City: Murray Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $59.50 - $91.84

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence (AI) platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment.

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The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.

All positions subject to close without notice. Thanks for your interest in continuing your career with our team!

Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up‑front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment.

Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery. Join our world‑class team and embark on a career filled with opportunities, strength, innovation, and fulfillment. Thank you for considering a career with us and experiencing our AI‑enhanced recruitment process.