Remote Medicare Advantage Operations Leader

Intermountain Healthcare Inc.; Santa Fe (NM); Remote; USD 82,000 - 127,000; Full time

Benefits offered by this job

AP4P Pay-for-Performance program

Remote work option with travel as‑need

Generous benefits package

Job summary

Intermountain Health is seeking an experienced leader to manage Medicare Advantage programs, ensuring regulatory compliance, operational excellence, and member satisfaction. You will partner with CMS P&L leadership, Product Leadership, and Market Presidents to drive performance and efficiency across the MA line of business.

The role requires strong program management, data analytics, and strategic planning skills to align with CMS requirements and annual product development cycles.

Qualifications

• Bachelor’s degree.
• 5+ direct years of Medicare Advantage experience.
• Experience with CMS audits, STAR ratings optimization, 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.

Responsibilities

• Lead and oversee daily market operations of the Medicare Advantage program, ensuring CMS compliance.
• Develop, implement, and optimize operational strategies to support enrollment, product development, member services, claims, utilization management, and care coordination.
• Ensure readiness for CMS audits, program reviews, and regulatory changes related to 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.
• Support oversight of delegated entities and vendor performance, including contract compliance and reporting.
• 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, benefit design changes, and AEP.

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 is seeking an experienced leader to manage Medicare Advantage programs, ensuring regulatory compliance, operational excellence, and member satisfaction. You will partner with CMS P&L leadership, Product Leadership, and Market Presidents to drive performance and efficiency across the MA line of business.

The role requires strong program management, data analytics, and strategic planning skills to align with CMS requirements and annual product development cycles.