Remote Medicare Advantage Program Leader

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

Job summary

Intermountain Health is seeking a senior leader to manage Medicare Advantage programs across markets, ensuring CMS compliance and end-to-end operational excellence. You will collaborate with P&L leadership, Product Leadership, and Market Presidents to optimize enrollment, product development, and member services while driving quality metrics and efficiency.

The role emphasizes regulatory alignment, data-driven improvement, and cross-functional partnerships to support strategic growth initiatives

Qualifications

• Bachelor’s degree required.
• 5+ direct years of Medicare Advantage experience.
• CMS audits, STAR ratings, and quality initiatives experience.
• Experience in payer operations or health plans.
• Knowledge of delegated/vendor management models.
• Lean, Six Sigma, or process improvement certification.

Responsibilities

• Lead daily market operations of the Medicare Advantage program ensuring CMS compliance.
• Develop and optimize operations for enrollment, product development, member services, claims, and care coordination.
• Prepare for CMS audits and regulatory changes within annual product cycles.
• Interpret CMS guidance with Compliance and Legal teams.
• Improve Star Ratings, member experience, and KPI performance with leadership.
• Oversee vendor performance and contract compliance.
• Collaborate with Finance on budgeting and cost management for MA operations.
• Foster local market accountability and continuous improvement.
• Support growth initiatives like new markets and AEP deployments.
• Use data reporting to identify trends and opportunities for operational enhancements.

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 is seeking a senior leader to manage Medicare Advantage programs across markets, ensuring CMS compliance and end-to-end operational excellence. You will collaborate with P&L leadership, Product Leadership, and Market Presidents to optimize enrollment, product development, and member services while driving quality metrics and efficiency.

The role emphasizes regulatory alignment, data-driven improvement, and cross-functional partnerships to support strategic growth initiatives