Medicare Operations Lead — Strategy & Compliance (Remote)

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

Benefits offered by this job

AP4P plan

Remote-friendly

Travel as needed

Job summary

Intermountain Health is seeking a senior leader to manage Medicare Advantage programs, partnering with P&L leadership and market presidents to drive end-to-end operational performance. You will ensure regulatory compliance and optimize enrollment, product development, and member services in a remote-capable role.

The role requires extensive Medicare Advantage experience, CMS familiarity, and proven ability to drive efficiency, quality outcomes, and strong stakeholder collaboration across

Qualifications

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

Responsibilities

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

Lean, Six Sigma, or other process improvement certification

Job description

Intermountain Health is seeking a senior leader to manage Medicare Advantage programs, partnering with P&L leadership and market presidents to drive end-to-end operational performance. You will ensure regulatory compliance and optimize enrollment, product development, and member services in a remote-capable role.

The role requires extensive Medicare Advantage experience, CMS familiarity, and proven ability to drive efficiency, quality outcomes, and strong stakeholder collaboration across