Case Management Supervisor

Sonoma Specialty Hospital•Sebastopol, CA

1d•Onsite

About The Position

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.

Requirements

Graduate of an accredited nursing program required
Current, unrestricted nursing license in the state of practice (LCSW may be considered for a social work-focused supervisory role)
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
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
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.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred
Master's degree in nursing, healthcare administration, or a related field preferred
CCM (Certified Case Manager), ACM-RN, or CPHM preferred
BLS preferred

Responsibilities

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
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
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
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
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