Senior Advisor - Medicare Advantage Plan Benefits/EGWPs

Position Title: Senior Advisor for Medicare Advantage Plan Benefits (EGWPs)

Work Location: Remote, U.S. based
Assignment Length: 1 year (through 03/31/2027)
Hours: Up to 10 hours per week

Salary: $89 - $95 per hour

Project Overview

Under Section 1115A of the Social Security Act, the CMS Innovation Center (CMMI) designs, tests, and expands innovative payment and service delivery models that reduce or maintain costs while preserving or improving quality of care.

The Senior Advisor will provide analytic, technical, and regulatory drafting support related to Employer Group Waiver Plans (EGWPs) within a new MA-focused models. This role advises on research, model design, payment methodology development, and rulemaking activities essential to the project's success.

Primary Purpose of the Role

The advisor will deliver expert policy, analytic, and regulatory support to design and operationalize new MA models related to EGWP payment and structure. This includes researching statutory authorities, developing policy options, and advising on regulatory materials supporting the models.

Key Duties & Responsibilities

Statutory & Regulatory Framework Review
* Review the statutory framework governing EGWPs, including SSA requirements, waiver authority, and Section 1115A authority to identify constraints, flexibilities, and impacts for model implementation.

Policy Analysis & Option Development
* Provide expertise on EGWP payment structure and anticipated impacts of the new MA model test.
* Advise on policy options that support model design and implementation.
* Advise on rulemaking language related to the model.

Research & Model Design Support
* Conduct policy research, environmental scanning, special studies, and analysis to inform model design decisions.

Education

• Master's degree in Economics, Business, Public Policy, Health Administration, Health Services Research, or related field.
  * Actuarial experience is a plus.

Experience

• Candidates must bring 10+ years of deep domain expertise in Medicare Advantage, with particular emphasis on EGWPs.
• Extensive understanding of how EGWPs function within MA, including distinctions between regulations and subregulatory guidance.
• Advising MA plans or employer groups on EGWP policy and operational considerations.
• Experience assessing flexibilities under Section 1115A authority.
• Ability to evaluate payment structures, compliance considerations, and implementation impacts.