Operations Supervisor - Medicare Advantage

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

Operations Supervisor - Medicare Advantage - 171487

Featured

Clearwater:Park Place | Business and Administrative | Full Time

Description

Why BayCare?

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area.Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

Summary:

• Accountable for the daily oversight and performance of key operational areas, including Appeals & Grievances (A&G), Call Center Services, and Intake functions supporting both A&G and Utilization Management (UM).
• Responsible for driving operational excellence, ensuring regulatory and accreditation compliance, and supporting member and provider satisfaction.
• Leads a team of frontline staff and is responsible for ensuring timely case resolution, accurate documentation, and consistent service delivery that meets CMS and NCQA standards.
• In addition to operational supervision, responsible for reporting, quality oversight, and contributing to continuous process improvement initiatives.
• Supports audit readiness, manages NCQA-required functions such as timely processing of grievances and appeals, and partners with Quality and Compliance teams to ensure adherence to policies and performance standards.
• Key responsibilities include supervise and support staff responsible for A&G processing, Call Center interactions, and Intake operations for A&G and UM.
• Ensures all grievance and appeal cases are processed within CMS and NCQA timeframes, with appropriate documentation and member/provider communication.
• Monitors daily productivity and performance metrics; escalates issues that may impact compliance or turnaround times.
• Develops and maintain dashboards, operational reports, and case tracking tools to support internal monitoring and external reporting requirements.
• Oversees quality assurance reviews to ensure accuracy, consistency, and compliance across all operational areas.
• Collaborates with Compliance and Quality teams to support NCQA accreditation standards, including documentation audits, quality improvement initiatives, and reporting requirements.
• Participates in internal and external audits, including preparation of required documentation and process evidence.
• Identifies training needs and facilitates knowledge transfer to ensure staff competency and regulatory understanding.
• Supports root cause analysis and the implementation of corrective action plans related to service failures, compliance findings, or quality variances.
• Fosters a culture of accountability, service excellence, and continuous improvement within the team.

Minimum Qualifications:

Education:

• High School Diploma or GED - Required
• Associate’s degree in healthcare administration, Business, or related field; Bachelor’s Degree strongly preferred or equivalent combination of education and experience.

Why BayCare?

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area.Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

Summary:

• Accountable for the daily oversight and performance of key operational areas, including Appeals & Grievances (A&G), Call Center Services, and Intake functions supporting both A&G and Utilization Management (UM).
• Responsible for driving operational excellence, ensuring regulatory and accreditation compliance, and supporting member and provider satisfaction.
• Leads a team of frontline staff and is responsible for ensuring timely case resolution, accurate documentation, and consistent service delivery that meets CMS and NCQA standards.
• In addition to operational supervision, responsible for reporting, quality oversight, and contributing to continuous process improvement initiatives.
• Supports audit readiness, manages NCQA-required functions such as timely processing of grievances and appeals, and partners with Quality and Compliance teams to ensure adherence to policies and performance standards.
• Key responsibilities include supervise and support staff responsible for A&G processing, Call Center interactions, and Intake operations for A&G and UM.
• Ensures all grievance and appeal cases are processed within CMS and NCQA timeframes, with appropriate documentation and member/provider communication.
• Monitors daily productivity and performance metrics; escalates issues that may impact compliance or turnaround times.
• Develops and maintain dashboards, operational reports, and case tracking tools to support internal monitoring and external reporting requirements.
• Oversees quality assurance reviews to ensure accuracy, consistency, and compliance across all operational areas.
• Collaborates with Compliance and Quality teams to support NCQA accreditation standards, including documentation audits, quality improvement initiatives, and reporting requirements.
• Participates in internal and external audits, including preparation of required documentation and process evidence.
• Identifies training needs and facilitates knowledge transfer to ensure staff competency and regulatory understanding.
• Supports root cause analysis and the implementation of corrective action plans related to service failures, compliance findings, or quality variances.
• Fosters a culture of accountability, service excellence, and continuous improvement within the team.

Minimum Qualifications:

Education:

• High School Diploma or GED - Required
• Associate’s degree in healthcare administration, Business, or related field; Bachelor’s Degree strongly preferred or equivalent combination of education and experience.

Experience:

• 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

Facility:BayCare Health System, Admin - Non Hospital Related-BHS

Location:300 Park Place Blvd. Clearwater, Fl 33759

Status: Full Time, Exempt: Yes

Weekend Work: None

On Call: No

How often will this team member be working remotely?Hybrid - 1 day/week - 1 day/month in office depending on business needs

Equal Opportunity Employer Veterans/Disabled