Case Management Supervisor

The Department of Case Management at SUNY Downstate Health Sciences University is seeking a full-time TH Senior Staff Associate / Case Management Supervisor.  

Position Summary

The Case Management Supervisor provides clinical and operational oversight of case management activities to support timely, coordinated, patient-centered care and effective hospital operations. The incumbent guides Case Managers in complex cases, supports utilization management and medical necessity reviews, facilitates interdisciplinary communication, and contributes to appropriate transitions of care, denial prevention, and reimbursement integrity. The position reports to the Director of Care Coordination.

Key Responsibilities 

Clinical Case Management and Care Coordination:

• Provide guidance and assistance to Case Managers in the assessment, management, and resolution of complex medical and surgical cases.
• Serve, in collaboration with the Physician Advisor, as a resource for difficult cases, barriers to discharge, and appropriate transitions of care.
• Facilitate patient and family conferences and education, as appropriate, to support discharge planning and continuity of care.
• Promote interdisciplinary collaboration among physicians, nursing, social work, revenue cycle, and other hospital stakeholders. 

Utilization Management and Revenue Integrity:

• Conduct and oversee initial and concurrent clinical reviews for managed care organizations and other payers, as appropriate.
• Apply approved evidence-based criteria, including MCG (Milliman Care Guidelines), to assess medical necessity, severity of illness, intensity of services, level of care, and appropriate care setting.
• Coordinate concurrent reconsiderations of potential denials and facilitate peer-to-peer discussions between treating physicians or the Physician Advisor and payer medical directors.
• Educate interdisciplinary teams on medical necessity, clinical documentation, and utilization management requirements. 

Supervision and Department Operations:

• Provide day-to-day oversight, coaching, and workflow support to Case Managers; escalate staffing and performance concerns to departmental leadership.
• Develop and maintain staff schedules and coordinate daily office operations to support appropriate coverage and efficient service delivery.
• Support responsible use of departmental fiscal and human resources within approved budgets and institutional policies.
• Maintain and help implement departmental operational policies, procedures, and standardized workflows. 

Quality, Collaboration, and Improvement:

• Represent the Department of Care Management at relevant hospital meetings, including utilization review, revenue cycle, and Epic-related workgroups.
• Support departmental initiatives, process improvements, issue resolution, and integration of related care management activities.
• Coordinate and participate in multidisciplinary projects with hospital personnel.
• Perform other related duties as assigned by the Director of Care Coordination.

Qualifications

Required Qualifications

• Bachelor of Science in Nursing (BSN) from an accredited institution.
• Current, unrestricted New York State Registered Nurse license.
• Five (5) years of progressive clinical nursing experience, including at least three (3) years in acute-care hospital case management, utilization management/review, discharge planning, or a closely related function.
• Demonstrated knowledge of medical necessity criteria, payer requirements, interdisciplinary care coordination, and transitions of care.
• Demonstrated ability to guide colleagues, prioritize complex workloads, and communicate effectively with clinical and administrative stakeholders.
• Or, a satisfactory equivalent combination of experience, education and training. 

Preferred Qualifications

• Master of Science in Nursing (MSN) or a related graduate degree in healthcare administration, public health, or a relevant discipline.
• Seven (7) or more years of progressive clinical nursing experience, including five (5) or more years in acute-care hospital case management or utilization management.
• Two (2) or more years of formal supervision, team leadership, or case management program coordination.
• Current case management certification, such as CCM or ACM, as appropriate to the role.
• Experience with MCG criteria, denial management, revenue cycle collaboration, and Epic or a comparable electronic health record.