Medicare Program Partner

Intermountain Health

8d • $60 - $92 • Remote

About The Position

This role manages Medicare Advantage-related programs for Select Health, including healthy living, wellness, and transportation programs. The Medicare Program Partner works with Medicare P&L leadership, Product Leadership, and Market Presidents to ensure end-to-end operational performance for the Medicare Advantage line of business. The role promotes operational excellence, regulatory compliance, alignment with CMS requirements, efficiency, quality outcomes, and member satisfaction.

The position oversees daily market operations and supports enrollment, product development, member services, claims, utilization management, care coordination, delegated entity and vendor oversight, budgeting, growth initiatives, and continuous improvement. It also prepares operations for CMS audits, program reviews, regulatory changes, and annual enrollment periods, using data and reporting to identify risks and opportunities.

This is an exempt, full-time remote position with business travel as needed. The role is based in Murray, Utah, and remote candidates may be considered subject to the stated state hiring restrictions. A Microsoft Teams video interview and potentially onsite interviews and meetings are required.

Requirements

• Bachelor’s degree.
• At least 5 years of direct 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.
• Skills in Medicare operations, leadership, project management, data analytics, strategic planning, communication, analytical thinking, and problem solving.

Nice To Haves

• Program management experience.

Responsibilities

• Lead and oversee daily Medicare Advantage market operations, ensuring compliance with CMS regulations and internal policies.
• Develop, implement, and optimize operational strategies supporting enrollment, product development, member services, claims, utilization management, and care coordination.
• Ensure operational readiness for CMS audits, program reviews, and regulatory changes related to the annual product development cycle.
• Partner with Compliance and Legal teams to interpret and operationalize CMS guidance, HPMS memos, and federal and state regulations.
• Drive improvements in Star Ratings, member experience, quality measures, and operational KPIs in partnership with Market Presidents, Product Leadership, and Medicare P&L leadership.
• Support oversight of delegated entities and vendor performance, including contract compliance and reporting, in collaboration with Compliance.
• Collaborate with Finance on budgeting, forecasting, and cost management for Medicare Advantage operations.
• Foster local market accountability and continuous improvement.
• Support growth initiatives, including new market entry, benefit design changes, and annual enrollment periods.
• Use data and reporting to identify trends, risks, and opportunities for operational enhancement.

Benefits

• Eligible to participate in the Annual Pay for Performance (AP4P) Plan, providing an additional performance compensation opportunity.
• A comprehensive benefits package covering programs to support well-being and a culture of wellness.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior