The posting
Job Description
The Department of Case Management at SUNY Downstate Health Sciences University is seeking a full-time TH Senior Staff Associate / Case Management Supervisor.
Position Summary
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.
Key Responsibilities
Clinical Case Management and Care Coordination:
- 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.
Utilization Management and Revenue Integrity:
- 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.
Supervision and Department Operations:
- Provide day-to-day oversight, coaching, and workflow support to Case Managers; escalate staffing and performance concerns to departmental leadership.
- Develop and maintain staff schedules and coordinate daily office operations to support appropriate coverage and efficient service delivery.
- Support responsible use of departmental fiscal and human resources within approved budgets and institutional policies.
- Maintain and help implement departmental operational policies, procedures, and standardized workflows.
Quality, Collaboration, and Improvement:
- Represent the Department of Care Management at relevant hospital meetings, including utilization review, revenue cycle, and Epic-related workgroups.
- Support departmental initiatives, process improvements, issue resolution, and integration of related care management activities.
- Coordinate and participate in multidisciplinary projects with hospital personnel.
- Perform other related duties as assigned by the Director of Care Coordination.
Qualifications
Required Qualifications
- Bachelor of Science in Nursing (BSN) from an accredited institution.
- Current, unrestricted New York State Registered Nurse license.
- Five (5) years of progressive clinical nursing experience, including at least three (3) years in acute-care hospital case management, utilization management/review, discharge planning, or a closely related function.
- Demonstrated knowledge of medical necessity criteria, payer requirements, interdisciplinary care coordination, and transitions of care.
- Demonstrated ability to guide colleagues, prioritize complex workloads, and communicate effectively with clinical and administrative stakeholders.
- Or, a satisfactory equivalent combination of experience, education and training.
Preferred Qualifications
- Master of Science in Nursing (MSN) or a related graduate degree in healthcare administration, public health, or a relevant discipline.
- Seven (7) or more years of progressive clinical nursing experience, including five (5) or more years in acute-care hospital case management or utilization management.
- Two (2) or more years of formal supervision, team leadership, or case management program coordination.
- Current case management certification, such as CCM or ACM, as appropriate to the role.
- Experience with MCG criteria, denial management, revenue cycle collaboration, and Epic or a comparable electronic health record.
About Us
Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.
Equal Employment Opportunity
SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.
Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply.
If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at [email protected].
