Manager, Medical Management and Regulatory Operations - Remote

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  

The Referral Navigator Supervisor is responsible for the day-to-day supervision, coordination, and operational performance of the Referral Navigator Department, including Home Health, Durable Medical Equipment (DME), Incomplete Referrals, Closed the Loop activities, authorization support functions, and other assigned Medical Management operations. This is a working supervisor position that actively participates in production activities while providing leadership, guidance, coaching, and operational support to Referral Navigators and, when applicable, Team Leads. The Supervisor is responsible for ensuring quality, productivity, timeliness, customer service, regulatory compliance, and achievement of departmental goals through effective workload management and staff development. This position is expected to exercise sound judgment, critical thinking, and operational problem-solving skills to identify practical solutions, improve workflow efficiency, and resolve operational issues independently whenever possible, escalating only those matters requiring higher-level leadership involvement.

If you are located in TX, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Performance
  • Provides direct supervision, leadership, coaching, and support for Referral Navigator staff and, when applicable, Team Lead personnel
  • Functions as a working supervisor by maintaining an active production workload while supporting daily departmental operations
  • Oversees operational activities related to Home Health, Durable Medical Equipment (DME), Incomplete Referrals, Closed the Loop processes, authorization support functions, and other assigned Medical Management workflows
  • Monitors work queues, inventory levels, staffing resources, production metrics, and operational performance indicators to ensure departmental goals are achieved
  • Provides guidance and support to staff regarding workflow processes, payer requirements, referral coordination, problem resolution, and customer service expectations
  • Coordinates daily workload assignments, queue balancing, staffing coverage, and operational priorities to support service level expectations
  • Participates in rotational phone queue coverage and ensures staff compliance with phone performance and customer service expectations
  • Conducts onboarding, training, coaching, mentoring, and performance development activities for assigned staff
  • Collaborates with clinics, providers, facilities, home health agencies, utilization management teams, medical reviewers, and operational partners to support efficient progression of member care requests
  • Promotes accountability, ownership, teamwork, professionalism, and service excellence throughout the department
• Compliance & Internal Quality
  • Ensures adherence to organizational policies, departmental procedures, accreditation standards, regulatory requirements, and payer-specific guidelines
  • Monitors quality performance through audits, case reviews, documentation reviews, and quality monitoring activities
  • Identifies quality concerns, process deficiencies, training opportunities, compliance risks, and operational issues and implements corrective actions as appropriate
  • Ensures accurate, timely, and audit-ready documentation of referral activities, communications, and operational actions
  • Supports implementation of departmental policies, workflow changes, quality initiatives, and corrective action plans
  • Conducts performance monitoring and provides feedback, coaching, and development opportunities to improve quality and consistency of work
  • Ensures staff maintain compliance with productivity, quality, documentation, and customer service expectations
• Timelines
  • Oversees daily operational performance to ensure referral