Remote Medicare Market Operations Leader

61000 SelectHealth Inc; Murray (KY); Remote; USD 83,000 - 127,000; Full time

Job summary

Intermountain Health’s Select Health in Murray seeks a Medicare Market Operations Partner to lead end-to-end MA program operations, ensuring CMS compliance and driving efficiency and member satisfaction.

You will collaborate with P&L leadership, Product leadership, and Market Presidents to implement strategies across enrollment, care coordination, and utilization management, while ensuring readiness for CMS audits and regulatory changes.

Qualifications

• Bachelor’s degree required.
• 5+ direct years of Medicare Advantage experience.
• Experience with CMS audits, STAR ratings optimization, and quality improvement.
• Background in payer operations 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 with regulations.
• Develop, implement, and optimize operational strategies for enrollment, product development, member services, claims, utilization management, and care coordination.
• Ensure operational readiness for CMS audits, program reviews, and regulatory changes during the annual product development cycle.
• Partner with Compliance and Legal teams to interpret CMS guidance, HPMS memos, and federal/state regulations.
• Drive performance improvements related to Star Ratings, member experience, quality measures, and KPIs with Market Presidents and leadership.
• Oversee vendor performance and contract compliance and reporting.
• Collaborate with Finance on budgeting, forecasting, and cost management.
• Foster local market accountability and continuous improvement.
• Support growth initiatives including new market entry and annual enrollment periods (AEP).
• Leverage data and reporting to identify trends, risks, and opportunities for operational enhancement.

Skills

Medicare Advantage

CMS audits

Star Ratings

Payer operations

Stakeholder management

Process improvement

Education

Bachelor's degree

Master's degree (MBA, MHA, MPH)

Job description

Intermountain Health’s Select Health in Murray seeks a Medicare Market Operations Partner to lead end-to-end MA program operations, ensuring CMS compliance and driving efficiency and member satisfaction.

You will collaborate with P&L leadership, Product leadership, and Market Presidents to implement strategies across enrollment, care coordination, and utilization management, while ensuring readiness for CMS audits and regulatory changes.