Case Management/Utilization Management Supervisor

Position Summary

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.

Duties

• 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.
• Forster 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

Required Qualifications:

• 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.

Preferred Qualifications:

• 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.

Special Notes:

Resume/CV should be included with the online application.

Posting Overview:

This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).
If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.

Anticipated Pay Range:

The salary range (or hiring range) for this position is $107,100 - $152,698 Base
The above salary range represents SBUH's good faith and reasonable estimate of the range of possible compensation at the time of posting. The specific salary offer will be based on the candidate's validated years of comparable experience. Any efforts to inflate or misrepresent experience are grounds for disqualification from the application process or termination of employment if hired.
Some positions offer annual supplemental pay such as:
• Location pay for UUP, CSEA & PEF full-time positions ($4000)
Your total compensation goes beyond the number in your paycheck. SBUH provides generous leave, health plans, and a state pension that add to your bottom line.