Remote Medicare Advantage Program Leader

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

Benefits offered by this job

Remote work option

AP4P pay-for-performance plan

Job summary

Intermountain Health’s Select Health division seeks a Senior Manager to oversee Medicare Advantage programs, partnering with CMS, Product Leadership, and Market Presidents to ensure compliance, efficiency, and member satisfaction in a fully remote capacity.

You will drive enrollment, claims, care coordination, audit readiness, and performance metrics, using data to identify risks and opportunities. Remote role with occasional travel; CMS guidelines experience required.

Qualifications

• Bachelor’s degree
• 5+ direct years of Medicare Advantage experience
• Relevant experience such as working 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

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 optimization, quality improvement

Payer operations / health plans / value-based care

Delegated and vendor management models

Lean, Six Sigma or process improvement certification

Job description

Intermountain Health’s Select Health division seeks a Senior Manager to oversee Medicare Advantage programs, partnering with CMS, Product Leadership, and Market Presidents to ensure compliance, efficiency, and member satisfaction in a fully remote capacity.

You will drive enrollment, claims, care coordination, audit readiness, and performance metrics, using data to identify risks and opportunities. Remote role with occasional travel; CMS guidelines experience required.