Medicare Program Partner

This is a fully remote position, open to applicants in Colorado, +5 more states.

📋 Description

• Direct and manage the daily market operations of the Medicare Advantage program.

• Ensure adherence to CMS regulations and internal policies.

• Create, implement, and enhance operational strategies that support enrollment, product development, member services, claims, utilization management, and care coordination.

• Prepare for operational readiness concerning CMS audits, program reviews, and regulatory changes throughout the annual product development cycle.

• Collaborate with Compliance and Legal teams to operationalize CMS guidance, HPMS memos, and federal/state regulations.

• Lead initiatives to improve Star Ratings, member experience, quality measures, and operational KPIs.

• Supervise delegated entity and vendor performance, ensuring contract adherence and reporting.

• Work with Finance on budgeting, forecasting, and cost management.

• Promote local market accountability and ongoing improvements.

• Assist with growth initiatives, new market entry, benefit design modifications, and annual enrollment periods.

• Leverage data and reporting to uncover trends, risks, and opportunities for operational enhancements.

⛳️ Requirements

• Bachelor’s degree.

• Over 5 years of direct experience in Medicare Advantage.

• Relevant experience involving CMS audits, STAR ratings optimization, and/or quality improvement initiatives.

• Experience in payer operations, health plans, or value-based care organizations.

• Familiarity with delegated and vendor management models.

• Certification in Lean, Six Sigma, or other process improvement methodologies.

• Capability to work remotely with occasional business travel as required.

• Candidates must reside in an eligible location; employment registration is maintained in Utah, Idaho, Nevada, Colorado, Montana, and Wyoming, while candidates from other locations may be considered.

• A video interview via Microsoft Teams is mandatory, with possible onsite interviews and meetings.

🏝️ Benefits

• Annual Pay for Performance (AP4P) Plan.

• Comprehensive benefits package that supports wellness, security, connection, and engagement.

• Fully remote work arrangement.

• Business travel as needed.