Remote Medicare Advantage Program Lead

Intermountain Healthcare Inc.; Salt Lake City (UT); Remote; USD 82,000 - 127,000; Full time

Job summary

Intermountain Health, Select Health unit in Murray, Utah, seeks a Medicare Advantage program leader to oversee operations for MA programs, ensuring CMS compliance, driving efficiency, and elevating member satisfaction across enrollment, product development, claims, and care coordination. This role partners with CMS leadership, product leadership and Market Presidents to optimize performance.

You will guide daily market operations, prepare for CMS audits, translate CMS guidance into operations,

Qualifications

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

5+ direct years of Medicare Advantage experience

CMS audits / STAR ratings / quality initiatives

Payer operations / health plans / value-based care

Delegated and vendor management models

Lean, Six Sigma or process improvement cert

Job description

Intermountain Health, Select Health unit in Murray, Utah, seeks a Medicare Advantage program leader to oversee operations for MA programs, ensuring CMS compliance, driving efficiency, and elevating member satisfaction across enrollment, product development, claims, and care coordination. This role partners with CMS leadership, product leadership and Market Presidents to optimize performance.

You will guide daily market operations, prepare for CMS audits, translate CMS guidance into operations,