Medicare Program Partner

Fully Remote

Select Health
- Murray

Select Health
- Idaho

Select Health
- Fort Collins

Select Health
- Lone Tree

Select Health
- Nevada

Full time

R169472

This role manages Medicare Advantage related programs (e.g. healthy living, wellness, and transportation related programs) for Select Health. This role partners with Medicare P&L leadership, Product Leadership, and Market Presidents to ensure the end-to-end operational performance of the organization’s Medicare Advantage line of business. This role ensures operational excellence, regulatory compliance, and alignment with CMS requirements while driving efficiency, quality outcomes, and member satisfaction.

• 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

• Medicare Operations
• Leadership
• Project Management
• Data analytics
• Strategic planning
• Communication
• Analytical skills
  
  Communication skills
• Problem Solving

• 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

• Program management experience

• This is an exempt, full-time position. Pay offers are determined by prior years of relevant experience within the established pay range. With this position, you are eligible to participate in the Annual Pay for Performance (AP4P) Plan. This plan enables Intermountain Health to provide leaders with an additional performance compensation opportunity.
• This position can be performed remotely with business travel as-needed. Intermountain Health maintains employment registration in Utah, Idaho, Nevada, Colorado, Montana, and Wyoming. Candidates in other locations may be considered. Currently, we are not hiring remote workers in the following states: CA, CT, HI, IL, MA, MN, NY, PA, RI, VT, and WA.
• Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings.

• Interact with others requiring the employee to communicate information.
• Operate computers and other office equipment requiring the ability to move fingers and hands.
• See and read computer monitors and documents.
• Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

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