Medicare Program Partner
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
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