Remote Medicare Advantage Programs Lead

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

Job summary

Intermountain Health seeks a senior leader to manage Medicare Advantage programs and related operations in a fully remote role. You will partner with Medicare P&L leadership, product leadership, and market presidents to ensure end-to-end performance, regulatory alignment, and continuous improvement across enrollment, claims, and care coordination.

You will drive Star Ratings and quality measures while coordinating with compliance, legal, and finance.

Qualifications

• Bachelor’s degree required and 5+ years MA experience.
• Experience with CMS audits, STAR ratings optimization, and quality initiatives.
• Background in payer operations or value-based care environments.
• Familiarity with delegated vendor management and process improvement.

Responsibilities

• Lead and oversee daily market operations of the Medicare Advantage program with CMS compliance.
• Develop and optimize operations for enrollment, product development, member services, claims, utilization management, and care coordination.
• Ensure readiness for CMS audits, program reviews, and regulatory changes during product cycles.
• Collaborate with Compliance, Legal, Finance and leadership to meet regulatory and financial targets.
• Drive Star Ratings, member experience, and KPIs with senior leadership and market teams.
• Oversee vendor performance, contract compliance, and reporting in partnership with compliance and finance.
• Support budgeting, forecasting, and cost management for MA operations.
• Foster accountability and continuous improvement across markets.
• Support growth initiatives including new markets, benefit design, and AEP processes.
• Use data to identify trends, risks, 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

5+ direct years of Medicare Advantage experience

CMS audits / STAR ratings experience

Payer operations / health plans

Delegated and vendor management

Lean, Six Sigma, or process improvement certification

Job description

Intermountain Health seeks a senior leader to manage Medicare Advantage programs and related operations in a fully remote role. You will partner with Medicare P&L leadership, product leadership, and market presidents to ensure end-to-end performance, regulatory alignment, and continuous improvement across enrollment, claims, and care coordination.

You will drive Star Ratings and quality measures while coordinating with compliance, legal, and finance.