Medicare Advantage Operations Lead (Hybrid)

Baycare; Clearwater (FL); Hybrid; USD 60,000 - 80,000; Full time

Job summary

BayCare in Clearwater, FL seeks an Operations Supervisor for Medicare Advantage. You will oversee Appeals & Grievances, Call Center, and Intake functions, leading staff to ensure timely case resolution and documentation in line with CMS/NCQA standards.

The role emphasizes regulatory compliance, reporting, and continuous process improvement, with hybrid work and close collaboration with Quality and Compliance teams.

Qualifications

• Minimum 4 years of experience in Healthcare Operations in a Medicare Advantage or Managed Care setting.
• Minimum 2 years of supervisory or team lead experience in a regulated Healthcare environment.
• Location: Clearwater, FL; Full Time, Exempt.

Responsibilities

• Oversee and drive performance of A&G, Call Center, and Intake functions.
• Ensure regulatory and accreditation compliance and provider/member satisfaction.
• Lead frontline staff and ensure timely case resolution and accurate documentation.
• Develop dashboards and reports to monitor performance and support reporting.
• Collaborate with Quality and Compliance to meet NCQA standards.

Skills

Supervisory experience

Regulatory compliance

Quality oversight

Reporting

Process improvement

Education

High School Diploma or GED

Associate’s degree in healthcare administration, Business, or related field

Bachelor’s Degree strongly preferred or equivalent combination of education and experience

Job description

BayCare in Clearwater, FL seeks an Operations Supervisor for Medicare Advantage. You will oversee Appeals & Grievances, Call Center, and Intake functions, leading staff to ensure timely case resolution and documentation in line with CMS/NCQA standards.

The role emphasizes regulatory compliance, reporting, and continuous process improvement, with hybrid work and close collaboration with Quality and Compliance teams.