Remote Medicare Advantage Program Lead

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

Job summary

Intermountain Health seeks a Medicare Advantage Operations Lead to manage programs across enrollment, CMS compliance, and performance optimization. You will partner with P&L leadership, Product, and Market Presidents to drive efficiency, quality outcomes, and member satisfaction within the MA line of business.

Responsibilities include overseeing daily market operations, preparing for CMS audits, coordinating with Compliance and Finance, and driving Star Ratings improvements while maintaining

Qualifications

• Bachelor’s degree (required)
• 5+ direct years of Medicare Advantage experience
• Experience with CMS audits, STAR ratings optimization, and quality improvement
• 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 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 Medicare Advantage Operations Lead to manage programs across enrollment, CMS compliance, and performance optimization. You will partner with P&L leadership, Product, and Market Presidents to drive efficiency, quality outcomes, and member satisfaction within the MA line of business.

Responsibilities include overseeing daily market operations, preparing for CMS audits, coordinating with Compliance and Finance, and driving Star Ratings improvements while maintaining