Remote Medicare Advantage Program Lead

Intermountain Health; Trenton (NJ); Remote; USD 82,000 - 127,000; Full time

Benefits offered by this job

Benefits package

Remote work option

Job summary

Intermountain Health is seeking a senior leader to manage Medicare Advantage programs and ensure regulatory compliance across the organization. You will partner with P&L leadership, product teams, and market presidents to deliver efficient operations, include audits, enrollment, and care coordination, and drive quality outcomes.

The role emphasizes strategic planning, vendor management, and leveraging data to improve Star ratings and member experience.

Qualifications

• Bachelor’s degree required.
• 5+ direct years of Medicare Advantage experience.
• Experience with CMS audits, STAR ratings optimization, or 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 CMS compliance and internal policies.
• Develop and optimize operational strategies to support enrollment, product development, member services, claims, utilization management, and care coordination.
• Ensure readiness for CMS audits, program reviews, and regulatory changes tied to annual product development.
• Interpret CMS guidance with Compliance and Legal teams and operationalize HPMS memos and regulations.
• Drive improvements in Star Ratings, member experience, and KPIs with leadership teams.
• Oversee vendor performance and contract compliance in collaboration with Compliance and Finance.
• Collaborate with Finance on budgeting, forecasting, and cost management for MA operations.
• Foster local market accountability and continuous improvement.
• Support growth through new markets, benefit design changes, and AEP periods.
• Use data 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

Medicare Advantage experience (5+ years)

CMS audits, STAR ratings, quality initiatives

Payer operations / value-based care

Vendor management experience

Lean, Six Sigma or equivalent

Job description

Intermountain Health is seeking a senior leader to manage Medicare Advantage programs and ensure regulatory compliance across the organization. You will partner with P&L leadership, product teams, and market presidents to deliver efficient operations, include audits, enrollment, and care coordination, and drive quality outcomes.

The role emphasizes strategic planning, vendor management, and leveraging data to improve Star ratings and member experience.