Description 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 Requirements 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.