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Director Medicare Operations Jobs (NOW HIRING)

CVS Health Corporation

$100 - $232/hr

## Lead Director, Medicare Advantage and Group ACA Risk Adjustment InformaticsApplyremote type ... Translate complex analytical findings into practical recommendations that improve operational ...

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Bcbsa

Head of Medicare Performance Hub

Chicago, IL

The Senior Director, Medicare Performance Hub (MPH) is a leadership role within the Blue Cross Blue Shield Association (BCBSA) Medicare business operations team. This individual will serve as the ...

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Director Medicare Operations information

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$34K

$107.7K

$179.5K

How much do director medicare operations jobs pay per year?

As of Aug 15, 2026, the average yearly pay for director medicare operations in the United States is $107,680.00, according to ZipRecruiter salary data. Most workers in this role earn between $75,500.00 and $135,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a director Medicare Operations?

To thrive as a Director of Medicare Operations, you need deep knowledge of Medicare regulations, healthcare administration, and operational leadership, often supported by a bachelor's or master's degree in healthcare or business. Familiarity with claims processing systems, CMS guidelines, and data analytics tools is typically required. Strong strategic thinking, problem-solving, and communication skills are essential for leading teams and ensuring regulatory compliance. These skills and qualities are vital for optimizing operational efficiency, maintaining compliance, and driving organizational success in the complex Medicare landscape.

What does a director Medicare Operations do?

A Director of Medicare Operations is responsible for overseeing the administration and management of Medicare-related programs within a healthcare organization or insurance company. This role involves ensuring compliance with federal and state regulations, optimizing operational efficiency, and leading teams that handle enrollment, claims processing, and customer service for Medicare members. The director also collaborates with other departments to implement strategic initiatives, improve quality of care, and ensure financial performance. Their leadership helps ensure that Medicare beneficiaries receive timely and accurate services while maintaining the organization's standards and objectives.

How does a director Medicare Operations typically collaborate with compliance and clinical teams to ensure regulatory adherence?

A Director of Medicare Operations plays a critical role in bridging operational processes with compliance and clinical teams. They regularly coordinate with compliance officers to interpret and implement CMS regulations, ensuring all processes meet federal standards. Additionally, they work closely with clinical leaders to design workflows that maintain both operational efficiency and high-quality patient care. This collaboration often involves frequent meetings, joint audits, and developing cross-functional training to address any regulatory or quality issues promptly.
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Director Medicare Operations jobs near you
Infographic showing various Director Medicare Operations job openings in the United States as of August 2026, with employment types broken down into 86% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $107,680 per year, or $51.8 per hour.

Medicare Membership & Eligibility Analyst (Temporary)

Central California Alliance for Health (Remote)

Sonoma, CA • On-site, Remote

$36 - $48/hr

Full-time, Temporary

Re-posted 15 days ago

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

ABOUT THIS TEMP POSITION

This is a temporary position and the length of assignment is estimated to go until December 31, 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Medicare Operations Director, this position:

  • Supports Medicare operations, sales, and enrollment functions through analysis and interpretation
    of Medicare and Medi-Cal data and ensures compliance with applicable state and federal
    regulations
  • Conducts complex research and analysis in support of Medicare Operations activities
  • Acts as a subject matter expert and liaison to internal and external stakeholders
WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements, click here.

  • Knowledge of:
    • CMS guidelines related to Medicare sales and enrollment
    • Medicare Advantage enrollment processes and financial reconciliation
    • Contents and interpretation of monthly membership reports
    • Research, analysis, and reporting methods
    • Data analysis tools, CRM/enrollment systems, and the use of databases
  • Ability to:
    • Analyze complex data sets and present actionable insights
    • Identify issues, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action
    • Interpret, explain and apply applicable policies, laws, codes, regulations, and contracts
    • Organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines
    • Assist with the development and implementation of projects, systems, programs, policies, and procedures
    • Develop and implement operational workflows
  • Education and Experience:
    • Bachelor's degree in Business Administration, Health Care Administration, Public Health, or a related field
    • Minimum of five years of progressively responsible experience related to Medicare membership operations and/or enrollment eligibility
    • Master's degree may substitute for two years of the required experience; or an equivalent combination of education and experience may be qualifying
OTHER INFORMATION
  • We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
  • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
  • In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
  • This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options.

COMPENSATION INFORMATION

  • Zone 1 Pay Range: $36.00 - $48.00
    Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
  • Zone 2 Pay Range: $34.00 - $45.00
    Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to answer any questions that you have or share the applicable pay zone for your location if it's not one of the typical areas listed. You can reach out to careers@thealliance.health, and a member from our Talent Acquisition team will be in touch.

The posted hiring ranges represent a good‑faith estimate of what a temporary employee would be paid on this assignment. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

OUR BENEFITS
  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 12 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • Onsite EV Charging Stations
  • And many more
ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.