Case Management/Utilization Management Supervisor

Stony Brook University•Town of Brookhaven, NY

18h•Onsite

About The Position

The Case Manager Supervisor plays a critical leadership role within the Care Management department, ensuring that clinical reviews, authorization processes, and appeal activities are carried out with accuracy, timeliness, and regulatory compliance. This position provides daily oversight and guidance to a team of utilization review nurses and appeals specialists, supporting them in making evidence-based decisions that promote appropriate resource utilization and safeguard organizational revenue. By monitoring performance, analyzing trends, and collaborating with interdisciplinary partners, the supervisor helps drive high-quality patient care, reduce avoidable denials, and strengthen the organization’s overall utilization management strategy. This role requires a blend of clinical expertise, operational insight, and strong communication skills to effectively lead staff and maintain positive relationships with payers, providers, and internal stakeholders. Qualified candidates will demonstrate superior patient care experience and possess outstanding communication skills while adhering to high standards of care.

Requirements

NYS RN License.
BSN Degree.
Five years of Utilization Review/Denials and Appeals experience in an Acute Care Hospital and/or five years of insurance-based utilization review.
Three to five years of supervisory experience.
Working knowledge of MCG or Interqual.
Knowledge of Regulatory agencies and standards of care.
Computer Skills in Word, Excel and PowerPoint.
Excellent Communication Skills. Creative, flexible, professional and courteous.
Weekday and weekend flexibility.

Nice To Haves

Master’s Degree.
Experience or Certified in Case Management, Quality, Risk, MCG, CDI or Utilization Management.
PRI certified.
Demonstrate experience in Appeal and Denial writing.
Proficient in Word and Excel and other computer skill sets.
Experience with Psychiatry, Pediatrics or Neonatal Care. Coding Experience.
Bilingual.

Responsibilities

Oversee daily operations of the Utilization Review and Denials & Appeals teams to ensure timely, accurate, and compliant work.
Assign, prioritize, and monitor caseloads to maintain productivity and meet turnaround requirements.
Ensure staff adhere to organizational policies, payer requirements, and regulatory standards.
Partner with Revenue Cycle, Coding, Finance, and Physician Advisors to optimize utilization and reduce financial risk.
Collaborate with physicians and clinical teams to clarify documentation, medical necessity, and discharge planning issues.
Serve as a liaison with payer representatives to resolve escalated issues and improve processes.
Provide direct supervision, coaching, and performance evaluations for UR nurses, coordinators, and appeals specialists.
Identify training needs and develop ongoing education to strengthen clinical review, documentation, and appeal-writing skills.
Facilitate team meetings, case discussions, and feedback sessions to promote continuous improvement.
Support staff in conducting concurrent, retrospective, and pre-service reviews using evidence-based criteria (e.g., InterQual, MCG).
Serve as an escalation point for complex cases requiring higher-level clinical judgment or payer communication.
Monitor adherence to medical necessity criteria and documentation standards.
Fostering a collaborative patient-centered team environment.
Support the financial goals and strategic plans of the hospital.
Demonstrates continued knowledge and commitment to professional growth and competence in Care Management.
Provide direction and guidance to Case Management staff for roles and responsibility.
Education of all staff with new processes.
Provides input and actively participates in performance improvement activities, staffing analysis, weekend activities.
Supervision on inpatient/ ED units.