Clinical Support Supervisor; Hybrid

Position: Clinical Support Supervisor (Hybrid)
** Resp & Qualifications*
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* PURPOSE:

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* The Clinical Support Supervisor is responsible for leading and overseeing a team of Quality Specialists to support quality improvement initiatives, care gap closure activities, regulatory compliance, and clinical performance outcomes for Medicare and Medicaid populations. This role plays a critical part in advancing organizational quality goals by ensuring adherence to NCQA accreditation standards, HEDIS quality measures, CMS regulatory requirements, and other applicable federal and state quality programs.

The Supervisor provides strategic leadership, coaching, and operational oversight to ensure Quality Specialists effectively execute interventions designed to improve preventive care, chronic disease management, medication adherence, and other quality measures. This position collaborates closely with provider network teams, care management, population health, analytics, and operational departments to implement data-driven strategies that improve member outcomes and maximize performance on key quality metrics.

The Clinical Support Supervisor is responsible for fostering a culture of accountability, collaboration, and professional development within the Quality Specialist team. Through ongoing performance monitoring, training, and mentorship, the Supervisor ensures staff are equipped to identify opportunities for quality improvement, resolve barriers to care gap closure, and effectively support organizational efforts to improve healthcare quality, member experience, and population health outcomes.

We are looking for an experienced people leader in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and at least two days a week at a Care First location based on business needs and work activities/deliverables that week.

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* ESSENTIAL FUNCTIONS:

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* + Supervises employee outcomes by training, assigning, scheduling, coaching, and counseling employees; communicating job expectations; planning, monitoring, and appraising job contributions; conducting and overseeing audits; and ensuring adherence to policies, procedures and regulations.

+ Meets operational standards by contributing information to strategic plans and reviews; implementing production, productivity, quality, and customer-service related standards; resolving people/process/technical problems; identifying system and/or process and workflow improvements. Supports the development of program descriptions, workflows, job aids and other SOPs related to non-clinical support teams and their activities.

+ Maintains departmental objectives by monitoring daily operations; resolving any issues that require manual review or technical support. Consistently supervises day-to-day clinical support operations and makes necessary adjustments where needed, including resources/staffing. Researches and resolves escalated cases, emails or telephone calls, reviews and resolves complex issues that have not been resolved by staff.

+ Maintains and improves clinical support operations by monitoring departmental and system performance; identifying and resolving problems; supervising process improvement and quality assurance programs; and supervises the process of conducting and following up on internal or external audits.

+ Prepare performance reports by collecting, analyzing, and summarizing data and trends.

+ Collaborates with members and/or family members, health care providers, community resource partners, and internal clinical and non-clinical colleagues to ensure effective service delivery and integration of member focused activities whether in Care Management, Utilization Review and/or Appeals…