Senior Advisor - Medicare Advantage Plan Benefits/EGWPs

ORAU

2d • Remote

About The Position

Under Section 1115A of the Social Security Act, the CMS Innovation Center (CMMI) designs, tests, and expands innovative payment and service delivery models that reduce or maintain costs while preserving or improving quality of care. The Senior Advisor will provide analytic, technical, and regulatory drafting support related to Employer Group Waiver Plans (EGWPs) within a new MA-focused models. This role advises on research, model design, payment methodology development, and rulemaking activities essential to the project’s success. The advisor will deliver expert policy, analytic, and regulatory support to design and operationalize new MA models related to EGWP payment and structure. This includes researching statutory authorities, developing policy options, and advising on regulatory materials supporting the models.

Requirements

• Master’s degree in Economics, Business, Public Policy, Health Administration, Health Services Research, or related field.
• 10+ years of deep domain expertise in Medicare Advantage, with particular emphasis on EGWPs.
• Extensive understanding of how EGWPs function within MA, including distinctions between regulations and sub‑regulatory guidance.
• Advising MA plans or employer groups on EGWP policy and operational considerations.
• Experience assessing flexibilities under Section 1115A authority.
• Ability to evaluate payment structures, compliance considerations, and implementation impacts.

Nice To Haves

• Actuarial experience is a plus.

Responsibilities

• Review the statutory framework governing EGWPs, including SSA requirements, waiver authority, and Section 1115A authority to identify constraints, flexibilities, and impacts for model implementation.
• Provide expertise on EGWP payment structure and anticipated impacts of the new MA model test.
• Advise on policy options that support model design and implementation.
• Advise on rulemaking language related to the model.
• Conduct policy research, environmental scanning, special studies, and analysis to inform model design decisions.

What This Job Offers

• Job Type: Part-time
• Career Level: Senior
• Number of Employees: 251-500 employees