Remote Medicare Advantage Program Lead

Intermountain Healthcare Inc.; Murray (UT); A distancia; USD 83.000 - 127.000; Jornada completa

Descripción de la vacante

Intermountain Health seeks a senior leader to manage Medicare Advantage programs, ensuring regulatory compliance and end-to-end operational performance across enrollment, product development, member services, and care coordination. You will drive efficiency, quality outcomes, and member satisfaction while aligning with CMS requirements and annual product cycles.

The role partners with Compliance, Legal, Finance, and Market Presidents to optimize operations, oversee vendor performance, and

Formación

• Bachelor’s degree
• 5+ direct years of Medicare Advantage experience
• Experience 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

Responsabilidades

• 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

Conocimientos

Medicare Operations

Leadership

Project Management

Data analytics

Strategic planning

Communication

Analytical skills

Problem Solving

Educación

Bachelor’s degree

Descripción del empleo

Intermountain Health seeks a senior leader to manage Medicare Advantage programs, ensuring regulatory compliance and end-to-end operational performance across enrollment, product development, member services, and care coordination. You will drive efficiency, quality outcomes, and member satisfaction while aligning with CMS requirements and annual product cycles.

The role partners with Compliance, Legal, Finance, and Market Presidents to optimize operations, oversee vendor performance, and