Medicare Program Partner

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

Benefits offered by this job

Annual Pay for Performance (AP4P) plan

Remote work option

PEAK program support

Job summary

Intermountain Healthcare Inc. is seeking a senior leader to oversee Medicare Advantage programs, ensuring CMS compliance and end-to-end operational performance. You will collaborate with P&L leadership, Product Leadership, and Market Presidents to optimize enrollment, product development, and member services.

The role emphasizes regulatory alignment, cost management, and drive for efficiency and quality outcomes across markets, including annual enrollment cycles and growth initiatives.

Qualifications

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

Responsibilities

• Lead and oversee daily market operations of the Medicare Advantage program with CMS compliance.
• Develop and optimize strategies for enrollment, product development, member services, claims, and care coordination.
• Ensure readiness for CMS audits, program reviews, and regulatory changes during product cycles.
• Interpret CMS guidance with Compliance and Legal; operationalize memos and regulations.
• Drive improvements in Star Ratings, member experience, and quality KPIs with leadership.
• Oversee vendor performance and contract compliance in collaboration with Compliance and Finance.
• Collaborate on budgeting, forecasting, and cost management for MA operations.
• Foster local market accountability and continuous improvement; support growth in new markets.
• Use data reporting to identify trends, risks, and opportunities for optimization.

Skills

Medicare Operations

Leadership

Project Management

Data analytics

Strategic planning

Communication

Analytical skills

Problem Solving

Education

Bachelor’s degree

Job description

Fully Remote

SelectHealth - Murray

SelectHealth - Idaho

SelectHealth - Fort Collins

SelectHealth - Lone Tree

SelectHealth - Nevada

Full time

R169472

Job Description

This role manages Medicare Advantage related programs (e.g. healthy living, wellness, and transportation related programs) for Select Health. This role partners with 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.

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

Skills

• Medicare Operations
• Leadership
• Project Management
• Data analytics
• Strategic planning
• Communication
• Analytical skillsCommunication skills
• Problem Solving

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

• Program management experience

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.

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

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.

Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

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.

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. Learn more. (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/peak-program/)

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!