Case Management Supervisor

Description

Job Description

Position 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.