Resp & Qualifications PURPOSE: 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 CareFirst location based on business needs and work activities/deliverables that week.
ESSENTIAL FUNCTIONS: - 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 functional areas.
SUPERVISORY RESPONSIBILITY: This position manages people.
QUALIFICATIONS: Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required
Experience: 3 years related professional experience with demonstrated leadership skills
Must have proficiency in clinical support and/or member and health care provider outreach activities.
Preferred Qualifications: - Proficiency in State or local regulations and/or compliance requirements related to healthcare delivery.
- Proficiency in medical management software or electronic platforms related to Care Management and Utilization Review.
- Bi-lingual
Knowledge, Skills and Abilities (KSAs) - Knowledge and experience in care coordination, clinical support, utilization view and/or member outreach operations.
- Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.
- Highly proficient in Microsoft Office programs including Word, Excel, and Power Point. Proficient in the use of web based electronic medical record or customer service systems.
- Excellent communication skills both written and verbal. Ability to positively influence others demonstrate respect and compassion. Strong presentation skills
Ability to plan, prioritize and organize work to meet changing priorities. Experienced with making decisions regarding work processes based on established guidelines. - Demonstration of critical and innovating thinking, as well as change leadership
Compile, analyze, and organize data and information from multiple sources to carry out assignments and inform leadership on operational performance. - Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $62,280 - $128,453
Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
PHYSICAL DEMANDS:The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US Must be eligible to work in the U.S. without Sponsorship
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