Operations Supervisor - Medicare Advantage

BayCare Health System; Clearwater Park (VA); Hybrid; USD 80,000 - 100,000; Full time

Job summary

BayCare Health System in the Tampa Bay area seeks a senior operations leader for Appeals & Grievances, Call Center Services and Intake functions supporting A&G and Utilization Management. You will oversee frontline staff, drive regulatory compliance, and deliver timely case resolution with CMS/NCQA standards.

You will develop dashboards, monitor performance, and partner with Quality and Compliance teams to support accreditation programs while ensuring staff competency and service excellence.

Qualifications

• Must have supervisory experience in a regulated healthcare environment.
• Experience ensuring CMS and NCQA compliance is preferred.
• Strong focus on data-driven reporting and continuous process improvement.

Responsibilities

• Oversee daily operations for Appeals & Grievances, Call Center Services, and Intake for A&G and UM.
• Drive operational excellence and ensure regulatory and accreditation compliance.
• Lead frontline staff, ensuring timely case resolution and accurate documentation.

Skills

Supervisory experience

Regulatory compliance

CMS NCQA standards

Operations management

Data reporting

Education

High School Diploma or GED

Associate’s degree in healthcare administration or related field

Bachelor’s Degree preferred

Job description

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.

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