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Manager Interqual Jobs in Colorado (NOW HIRING)

Mission Hospital

RN Case Manager Weekend Plan

Aurora, CO · On-site

$40.35 - $58.87/hr

Provides case management services for both inpatient and observation patients as assigned ... Evaluates progression of care using evidence-based tools and approved criteria (InterQual ...

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Manager Interqual information

How does a Manager Interqual typically collaborate with clinical and administrative teams to ensure effective utilization review?

A Manager Interqual works closely with both clinical staff—such as physicians, nurses, and case managers—and administrative teams to implement and oversee the use of InterQual criteria in utilization review processes. They facilitate training, address questions about criteria application, and help resolve discrepancies between clinical recommendations and insurance requirements. Regular meetings and interdisciplinary rounds are common, ensuring that patient care decisions are well-documented and meet regulatory standards. This collaborative approach helps streamline approvals, reduce denials, and maintain high-quality patient care.

What is the difference between Manager Interqual vs Clinical Case Manager?

AspectManager InterqualClinical Case Manager
CredentialsTypically requires nursing or healthcare management certificationsRequires nursing or social work licensure and clinical experience
Work EnvironmentHealthcare organizations, utilization review departmentsHospitals, insurance companies, community health settings
Primary FocusUtilization management, policy implementation, and compliancePatient advocacy, care coordination, and discharge planning

The Manager Interqual primarily oversees utilization review processes and policy adherence within healthcare organizations, often requiring management experience and specific certifications. In contrast, the Clinical Case Manager focuses on direct patient care, coordinating services, and ensuring appropriate treatment. Both roles are vital in healthcare but serve different functions related to patient care and resource management.

What are the key skills and qualifications needed to thrive as a Manager Interqual, and why are they important?

To excel as a Manager Interqual, you need a solid background in healthcare management, clinical guidelines, and utilization review processes, typically supported by a nursing or clinical degree and relevant experience. Familiarity with InterQual criteria, case management software, and healthcare compliance systems is crucial. Strong leadership, analytical thinking, and effective communication are valuable soft skills for guiding teams and collaborating with diverse stakeholders. These competencies ensure proper application of clinical criteria, optimize resource utilization, and support quality patient care and regulatory compliance.

What is a Manager Interqual?

A Manager Interqual is a healthcare management professional responsible for overseeing the use and implementation of the InterQual criteria within a healthcare organization. InterQual is a set of evidence-based clinical decision support tools used to ensure appropriate hospital admissions, continued stays, and other medical services. The Manager Interqual leads teams that review cases for medical necessity, ensures compliance with regulatory requirements, and collaborates with clinical staff to optimize patient care and resource utilization. They also provide training on InterQual standards and help integrate these criteria into hospital processes.
Manager Interqual jobs near you

RN- MANAGED CARE ADMINISTRATION

Careers Integrated Resources Inc

Denver, CO • On-site

Other

Medical

Posted 4 days ago

Job description

RN- MANAGED CARE ADMINISTRATION

The facility in Denver seeks 2 F/T RN Case Managers for excellent contract working in Managed Care department.

Responsibilities:

  • Must have BSN, 3 years' experience in medical utilization management, and experience working with a health insurance plan.
  • Managed Care experience is preferred however hospital experience is also considered.
  • Seeking highly skilled individual with experience with InterQUal and MCG.
  • Provides medical and/or behavioral health utilization management for members of facility medical plan in accordance with the schedule of benefits and network criteria defined by the Plans various lines of business and Center for Medicare & Medicaid Services.
Additional Information

TITLE: RN - MANAGED CARE ADMINISTRATION.

LOCATION: DENVER, CO 80204.

DURATION: 3+ MONTHS.

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