Job Type
Full-time
Description
Job DescriptionPosition Title: Case Management Supervisor
Department: Case Management
Reports To: Administrator/ CNO
FLSA Status: Exempt
Job Summary:The Case Management Supervisor oversees the daily operations of the case management team in a Long-Term Acute Care Hospital. This role ensures that patients with complex, medically intensive needs receive timely admission review, appropriate level-of-care determinations, effective utilization management, and safe, well-coordinated discharge planning. The Supervisor balances clinical quality, regulatory compliance, payer requirements, and length-of-stay goals while providing leadership, coaching, and support to the case management team.
Essential Duties and Responsibilities: Team Leadership and Supervision - Supervise, schedule, and evaluate case managers, social workers, and utilization review staff
- Assign caseloads and adjust staffing to meet census and acuity needs
- Conduct new-hire orientation, competency validation, and ongoing education
- Provide coaching, performance feedback, and corrective action as needed
- Serve as a clinical resource and escalation point for complex or difficult cases
- Foster a collaborative team culture and support staff retention and engagement
Admission and Utilization Management - Oversee pre-admission screening and referral review to confirm patients meet LTACH clinical criteria (e.g., InterQual or MCG)
- Ensure timely initial authorizations, concurrent reviews, and continued-stay reviews with payers
- Manage payer denials, peer-to-peer requests, and the appeals process
- Monitor compliance with the CMS LTCH Prospective Payment System (PPS) site-neutral payment criteria and the 25-day average length-of-stay requirement
- Track observation of Medicare short-stay outlier and high-cost outlier thresholds
Discharge Planning and Care Transitions - Ensure every patient has an individualized, interdisciplinary plan of care with a documented discharge plan beginning at admission
- Oversee safe transitions to home, home health, skilled nursing, inpatient rehab, acute care, or hospice
- Coordinate with physicians, nursing, respiratory therapy, therapy, pharmacy, and families in regular interdisciplinary team (IDT) meetings
- Address barriers to discharge, including placement, DME, ventilator or wound care needs, and funding
- Lead patient and family education regarding goals of care, prognosis, and post-acute options, including palliative and hospice referrals
Quality, Compliance, and Reporting - Ensure compliance with CMS Conditions of Participation, Joint Commission or other accrediting body standards, and state regulations
- Monitor key metrics: average length of stay, readmission and interrupted-stay rates, denial rates, discharge disposition, and avoidable days
- Prepare and present regular reports to leadership and participate in QAPI and utilization review committees
- Audit documentation for accuracy, timeliness, and medical necessity
- Ensure adherence to patient rights, HIPAA, and ethical standards
Collaboration and Community Relations - Serve as liaison with referring acute care hospitals, payers, post-acute providers, and community agencies
- Support marketing and clinical liaison teams in evaluating appropriate referrals
- Participating in physician advisor and interdisciplinary rounds
Performance Measures (Examples): - Average length of stay within target range and compliant with the LTCH 25-day threshold
- Timely completion of authorizations and concurrent reviews
- Denial overturn rate and reduction in avoidable days
- Discharge disposition and readmission targets
- Staff engagement, retention, and competency completion
Requirements
Education, Training, and Licenses Required:- Graduate of an accredited nursing program required; Bachelor of Science in Nursing (BSN) preferred
- Master's degree in nursing, healthcare administration, or a related field preferred
- Licensure and Certification
- Current, unrestricted nursing license in the state of practice (LCSW may be considered for a social work-focused supervisory role)
- CCM (Certified Case Manager), ACM-RN, or CPHM preferred
- BLS preferred
Experience:- Minimum 2-3 years of case management or utilization review experience in an acute care hospital, LTACH, or post-acute setting\
- Minimum 1-2 years of supervisory or leadership experience preferred
- Working knowledge of Medicare, Medicaid, and commercial payer processes, LTCH PPS, and InterQual or MCG criteria
- Knowledge, Skills, and Abilities:
- Strong understanding of medically complex conditions (ventilator weaning, wound care, sepsis, multi-system failure, and complex infections)
- Excellent communication, negotiation, and conflict-resolution skills
- Ability to analyze data and translate it into operational improvements
- Proficiency with EMR and case management software and Microsoft Office
- Sound clinical judgment and ability to prioritize in a fast-paced environment
Supervisory Requirements (if applicable): Case Managers, Social Workers, Utilization Review staff, Discharge Planners
Physical Requirements:While performing the duties of this job, the position is frequently required to do the following:
- Primarily an office and clinical unit environment; may involve prolonged sitting, walking, and computer use.
- Ability to lift up to 25 lbs. occasionally.
- Exposure to patients with infectious diseases; adherence to infection control and PPE protocols.
- May require on-call availability, occasional weekend coverage, or flexibility during high-census periods.
Salary Description
$104000/year - $114,400/year
