Operations Supervisor - Medicare Advantage

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.

About the Role

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.

Responsibilities

• Supervise and support staff responsible for A&G processing, Call Center interactions, and Intake operations for A&G and UM.
• Ensure all grievance and appeal cases are processed within CMS and NCQA timeframes, with appropriate documentation and member/provider communication.
• Monitor daily productivity and performance metrics; escalate issues that may impact compliance or turnaround times.
• Develop and maintain dashboards, operational reports, and case tracking tools to support internal monitoring and external reporting requirements.
• Oversee quality assurance reviews to ensure accuracy, consistency, and compliance across all operational areas.
• Collaborate with Compliance and Quality teams to support NCQA accreditation standards, including documentation audits, quality improvement initiatives, and reporting requirements.
• Participate in internal and external audits, including preparation of required documentation and process evidence.
• Identify training needs and facilitate knowledge transfer to ensure staff competency and regulatory understanding.
• Support root cause analysis and the implementation of corrective action plans related to service failures, compliance findings, or quality variances.
• Foster a culture of accountability, service excellence, and continuous improvement within the team.

Qualifications

• 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.

Schedule

Full Time, Exempt: Yes. Weekend Work: None. On Call: No. Hybrid — 1 day/week to 1 day/month in office depending on business needs.

Location

BayCare Health System, Admin - Non Hospital Related-BHS, 300 Park Place Blvd., Clearwater, FL 33759.