Case Management Supervisor

About the role

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.

Responsibilities

• 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.
• 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.
• Provide day-to-day oversight, coaching, and workflow