Clinical Support Supervisor (Hybrid)

CareFirst•Baltimore, MD

1d•Hybrid

About The Position

The Community Health Navigator Supervisor is responsible for leading and overseeing a team of Community Health Navigators to support member engagement, care coordination, and quality performance initiatives specifically aligned with Medicare and Medicaid populations. This role plays a critical part in driving improved health outcomes, reducing care gaps, and ensuring compliance with NCQA accreditation standards, HEDIS quality measures, and CMS regulatory requirements. The Supervisor provides strategic direction, coaching, and operational oversight to ensure that outreach and navigation activities effectively identify and close gaps in care, including preventive screenings, chronic condition management, and follow-up care. This position works closely with internal quality, case management, and provider network teams to support data-driven interventions that improve performance on key quality metrics. In alignment with organizational goals, the Community Health Navigator Supervisor ensures that workflows, documentation, and member interactions consistently reflect evidence-based practices and regulatory standards required by CMS and NCQA. The role is accountable for monitoring team performance, ensuring accurate tracking of outreach efforts, and validating that all activities contribute to improved HEDIS scores and overall quality ratings.

Requirements

Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work 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.
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 other demonstrating 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.
Must be eligible to work in the U.S. without Sponsorship

Nice To Haves

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

Responsibilities

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.
Supervises team members in the field during field outreach, attends and host member and community health fairs.
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, review 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.
Prepares 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 clincial 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.