Remote Medicare Advantage Program Lead

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

Benefits offered by this job

AP4P Plan

Remote work possible

Competitive benefits

Job summary

Intermountain Health is seeking a remote Medicare Advantage program leader to manage end-to-end operations, drive regulatory compliance, and oversee performance improvements across enrollment, claims, and care coordination.

The role collaborates with CMS leadership, product and market teams, and vendors to optimize efficiency, quality, and member satisfaction, while aligning with CMS requirements and annual product cycles.

Qualifications

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

Leadership

Project Mgmt

Data Analytics

Strategic Planning

Communication

Analytical Skills

Communication Skills

Problem Solving

Education

Bachelor’s degree

Job description

Intermountain Health is seeking a remote Medicare Advantage program leader to manage end-to-end operations, drive regulatory compliance, and oversee performance improvements across enrollment, claims, and care coordination.

The role collaborates with CMS leadership, product and market teams, and vendors to optimize efficiency, quality, and member satisfaction, while aligning with CMS requirements and annual product cycles.