South Midwest HERC

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 of a Case Manager Supervisor include the following but are not limited to:

* 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.

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• Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
• All Hospital positions maybe subject to changes in pass days and shifts as necessary.
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
• This function/position maybe designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.

Prior to start date, the selected candidate must meet the following requirements:

• Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
• Complete electronic reference check with a minimum of three (3) professional references.
• Successfully complete a 4 panel drug screen*
• Meet Regulatory Requirements for pre employment screenings.
• Provide a copy of any required New York State license(s)/certificate(s).

Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.

*The hiring department will be responsible for any fee incurred for examination.

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Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.

If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280.

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Stony Brook University Hospital, consistent with our shared core values and our intent to achieve excellence, remains dedicated to supporting healthier and more resilient communities, both locally and globally.

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.