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Manager Interqual Jobs in Colorado (NOW HIRING)

RN Case Manager in Aurora, CO

Aurora, CO · On-site

$40.35 - $58.87/hr

RN Case Manager Hourly Wage Estimate: $40.35 - $58.87 / hour Learn more about the for this job. The ... Interqual experience preferred Benefits HCA HealthONE Aurora, offers a total rewards package that ...

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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.

$40.35 - $58.87/hr

Full-time, Per diem

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago


Job description

Hourly Wage Estimate: $40.35 - $58.87 / hour
Learn more about the benefits offered for this job.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

Ready for a role that supports your unique calling in patient care and fits your life? At HCA HealthONE Presbyterian St. Luke's, 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

The Registered Nurse (RN) CM 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 CM facilitates the progression and transition of care using established criteria and in conjunction with the multidisciplinary team. The RN CM will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization. Your responsibilities will include:

  • Guiding patients and families through program orientation, explaining the rehabilitation philosophy, Medicare and insurance benefits, discharge criteria, and patient rights
  • Coordinating education for patients, families, and caregivers to encourage participation in treatment planning, goal discussions, and family conferences
  • Developing and implementing individualized treatment plans that reflect the patient’s strengths, needs, and personal recovery goals
  • Completing psychosocial assessments and discharge planning evaluations, clearly documenting findings and communicating needs across the care team
  • Collaborating closely with the Rehab Program Director, Facility Case Management Director, and interdisciplinary team to ensure seamless, patient-centered care
  • Promoting HCA Healthcare’s values of compassion, respect, and excellence through every patient and family interaction
What qualifications you will need:
  • Associate Degree in Nursing or Nursing Diploma Required
  • Bachelor’s Degree in Nursing Preferred
  • 2+ years experience in case management OR 3+ years experience in clinical nursing Required
  • InterQual experience Preferred
Benefits

HCA HealthONE Presbyterian St. Luke's, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

  • Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
  • Wellbeing support, including free counseling and referral services
  • Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
  • Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
  • Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
  • Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

HCA HealthONE, one of the largest and most comprehensive healthcare systems in the Rocky Mountain region, offers more than 170 care sites in the Denver metro area. Offering services across the continuum of care to meet patients’ total healthcare needs, HCA HealthONE includes seven acute care hospitals, a dedicated flagship pediatric hospital, a rehabilitation hospital, CareNow® urgent care clinics, mental health campuses, imaging and surgery centers, physician practices, home and hospice care, and AirLife Denver, which provides regional critical care air and ground transportation. Among HCA HealthONE’s acute care hospitals is Presbyterian/St. Luke’s (P/SL). P/SL has been meeting the healthcare needs of patients and their families from across the Rocky Mountain region for more than 140 years. Included on the P/SL campus is Rocky Mountain Children’s, a dedicated pediatric hospital, making the campus the only tertiary/quaternary combined pediatric and adult hospital in this region. P/SL is home to an award-winning cancer program including the Colorado Blood Cancer Institute, a solid organ transplant program, and complex orthopedics. Consistently among the Denver Business Journals’ list of top corporate philanthropists in the Denver-metro area, HCA HealthONE was named as one of the most community-minded organizations by The Civic 50 and contributed more than $1 million through cash and in-kind donations last year alone, along with more than $400M in federal, state and local taxes.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Nurses are essential to the delivery of healthcare and serve as its foundation. At HCA Healthcare, we are committed to equipping nurses with the tools and resources they need to deliver exceptional patient care, championing the profession, and supporting the advancement of nursing’s future."

Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC

Senior Vice President and Chief Nurse Executive

HCA Healthcaret

Join a family that cares about every stage in your career! We are interviewing candidates for our RN Case Manager PRN opening. Apply today and a member of our Talent Acquisition team will reach out.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.