Remote Medicare Advantage Program Lead

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

Job summary

Intermountain Health seeks a senior leader to manage Medicare Advantage programs across markets, ensuring CMS compliance and end-to-end operational excellence. You will drive enrollment, product development, and care coordination with cross-functional teams.

Responsibilities include optimizing STAR ratings, monitoring KPIs, and ensuring readiness for CMS audits. This remote role supports multiple markets, with travel as needed and alignment to Intermountain's payer operations expertise.

Qualifications

• Bachelor’s degree required.
• 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.
• 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 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 seeks a senior leader to manage Medicare Advantage programs across markets, ensuring CMS compliance and end-to-end operational excellence. You will drive enrollment, product development, and care coordination with cross-functional teams.

Responsibilities include optimizing STAR ratings, monitoring KPIs, and ensuring readiness for CMS audits. This remote role supports multiple markets, with travel as needed and alignment to Intermountain's payer operations expertise.