Case Management Supervisor in Sebastopol, California at SONOMA SPECIALTY HOSPITAL

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

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.