RN Case Manager
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance. * Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier ...
Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance. * Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier ...
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
New
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
New
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Fort Worth, TX · On-site
InterQual experience preferred Benefits Medical City Fort Worth, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
InterQual experience preferred Benefits Medical City Arlington, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
InterQual experience preferred Benefits Medical City Arlington, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
Lewisville, TX · On-site
InterQual experience preferred Benefits Medical City Lewisville, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Lewisville, TX · On-site
InterQual experience preferred Benefits Medical City Lewisville, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Houston Heights, TX · Remote
$60K - $107K/yr
Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria) * Discuss cases with facility healthcare professionals to obtain plans-of-care
Houston Heights, TX · Remote
$60K - $107K/yr
Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria) * Discuss cases with facility healthcare professionals to obtain plans-of-care
Rowlett, TX · On-site
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
Rowlett, TX · On-site
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
Irving, TX · On-site
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
Irving, TX · On-site
InterQual experience preferred Benefits Medical City Heart & Spine Hospitals, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...
Professionals utilizing InterQual criteria are primarily responsible for reviewing medical records and assessing whether inpatient admissions, procedures, or continued stays meet established clinical guidelines. Daily tasks often include documenting findings, communicating with physicians and care teams to clarify case details, and collaborating with insurance companies regarding authorization of services. These professionals act as a key resource for ensuring compliance with industry standards and optimizing patient care pathways. Successful InterQual specialists proactively identify discrepancies and help resolve issues that might delay care or reimbursement. You can expect regular interaction with both clinical and administrative staff in a fast-paced healthcare environment.
To excel in a role focused on InterQual, such as an InterQual Specialist or Utilization Review Nurse, you need a strong background in healthcare, clinical assessment skills, and familiarity with utilization management. Proficiency in using InterQual software, electronic health records (EHRs), and knowledge of medical necessity criteria are essential, and certification in case management or utilization review is often preferred. Attention to detail, strong analytical thinking, and effective communication are critical soft skills for this position. These skills ensure accurate case evaluations, appropriate care decisions, and efficient collaboration with healthcare providers and payer organizations.
An InterQual job typically involves using InterQual criteria—a set of evidence-based guidelines—to assess medical necessity for healthcare services. Professionals in these roles, such as nurses or case managers, review patient cases to ensure treatments align with best practices and insurance requirements. They work in hospitals, insurance companies, or healthcare organizations to support utilization management and improve patient care efficiency. Strong clinical knowledge and familiarity with InterQual software are often required for these positions.

Other
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 21 days ago
6.3
Based on 44 frontline employees who took The Breakroom Quiz
778th of 1,055 rated hospitals
Ready for a role that supports your unique calling in patient care and fits your life? At Medical City Fort Worth, you'll find clear pathways to advance backed by our unmatched nationwide transfer policy that lets you grow your career when the time is right for you. With mentorship opportunities, clinical education courses, professional certification support, and educational assistance, you will have all the resources you need to build the career of a lifetime.
Job Summary and Qualifications
* This is a Full Time Day Shift position, hours are typically 8:00am-4:30pm Monday - Friday with some weekends *
Our RN Case Managers raise the bar by providing clinical expertise and the highest quality care in the most compassionate way. The RN Case Manager is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. The RN Case Manager facilitates the progression and transition of care using established criteria and in conjunction with the multidisciplinary team. The RN Case Manager will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization.
What You Will Do In This Role:
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