Job Description:
• Lead and oversee daily market operations of the Medicare Advantage program
• Ensure 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 during the annual product development cycle
• Partner with Compliance and Legal teams to operationalize CMS guidance, HPMS memos, and federal/state regulations
• Drive improvements in Star Ratings, member experience, quality measures, and operational KPIs
• Oversee delegated entity and vendor performance, including contract compliance and reporting
• Collaborate with Finance on budgeting, forecasting, and cost management
• Foster local market accountability and continuous improvement
• Support growth initiatives, new market entry, benefit design changes, and annual enrollment periods
• Use data and reporting to identify trends, risks, and operational enhancement opportunities
Requirements:
• 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
• Ability to work remotely with business travel as-needed
• Candidates must reside in an eligible location; employment registration is maintained in Utah, Idaho, Nevada, Colorado, Montana, and Wyoming, while candidates in other locations may be considered
• Video interview through Microsoft Teams required, with potential onsite interviews and meetings
Benefits:
• Annual Pay for Performance (AP4P) Plan
• Comprehensive benefits package covering programs supporting wellness, security, connection, and engagement
• Fully remote work arrangement
• Business travel as-needed
Apply To This Job