Operations Supervisor - Medicare Advantage

At Bay Care, 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.

• 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 time frames, 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.

• 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.

• 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: Bay Care 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

Hybrid - 1 day/week - 1 day/month in office depending on business needs

Equal Opportunity Employer Veterans/Disabled