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Manager Interqual Jobs in Illinois (NOW HIRING)

Saint Joseph Medical Center - Joliet

Case Manager

Joliet, IL · On-site

$35.35 - $53.58/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Joliet, IL 60435 Responsibilities Responsible for the quality and resource management of all ... Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate ...

Prime Healthcare

Case Manager

Joliet, IL

$35.35 - $53.58/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Joliet, IL 60435 Responsible for the quality and resource management of all patients that are ... and InterQual Criteria preferred. 7. Current BCLS certificate, preferred #LI-GM1 Saint Joseph ...

Saint Joseph Medical Center - Joliet

Case Manager

Joliet, IL · On-site

$35.35 - $53.58/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Joliet, IL 60435 Responsibilities Responsible for the quality and resource management of all ... Criteria and InterQual Criteria preferred. 7. Current BCLS certificate, preferred #LI-GM1 Pay ...

Prime Healthcare

RN Case Manager Social Worker

Chicago, IL · On-site

$35.35 - $47.58/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Location: 7435 W Talcott Ave, Chicago, IL 60631 Responsible for the quality and resource management ... and InterQual Criteria preferred. 7. Current BCLS certificate, preferred Resurrection Medical ...

Sih

Weekend Option RN Case Manager

Carbondale, IL · On-site

$68K - $106K/yr

Maintains competency in InterQual criteria. Collaborate with social work team to address social ... Assists manager with data collection, analysis and distribution as needed. Compensation ...

Endeavor Health Services

RN Care Manager

Evanston, IL · On-site

$40.45 - $62.70/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

RN Care Manager-Weekend Hourly Pay Range: $40.45 - $62.70 - The hourly pay rate offered is ... Knowledge of InterQual or MCG criteria is preferred. What You Will Do: * Facilitates payor ...

Endeavor Health Services

RN Care Manager

Highland Park, IL · On-site

$40.45 - $62.70/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

RN Care Manager Hourly Pay Range: $40.45 - $62.70 - The hourly pay rate offered is determined by a ... Knowledge of InterQual or MCG criteria is preferred. What you will do: * Facilitates payor ...

Prime Healthcare

RN Case Manager Social Worker

Chicago, IL · On-site

$35.35 - $47.58/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

At least one year experience in case management, discharge planning or nursing management3 ... Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate ...

Med-Metrix

Physician Advisor - Remote

Chicago, IL · On-site +1

Possess a working knowledge of (Hospital) organization & case management operations and administrative standards and policies * Familiarity with MCG/InterQual placement status criteria is preferred

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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.

What are the most commonly searched types of Interqual jobs in Illinois?

The most popular types of Interqual jobs in Illinois are:

Manager Interqual jobs near you

RN Utilization Review Case Manager

Gateway Regional Medical Center

Granite City, IL • On-site

$32 - $48/hr

Full-time

Medical, Dental, Vision, PTO

Re-posted 24 days ago

Gateway Regional Medical Center rating

4.4

Company rating: 4.4 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

1,030th of 1,059 rated hospitals

Job description

Utilization Review Specialist RNFull-Time | Case Management | Gateway Regional Medical Center | Granite City, IllinoisGateway Regional Medical Center is hiring a Utilization Review Specialist Registered Nurse (RN) to join our Case Management team.This role is ideal for an experienced acute care nurse who is ready to move into a more analytical, process-driven role focused on appropriate utilization of services, payer compliance, and supporting high-quality, cost-effective patient care.What You'll DoIn this role, you will support appropriate patient care utilization and financial stewardship by:Completing admission and concurrent chart reviews for medical necessityWorking to prevent denials from all payers through timely review and documentationManaging and coordinating appeals for denied or at-risk accountsCollaborating with physicians, case managers, and interdisciplinary teamsMonitoring payer requirements and regulatory compliance standardsIdentifying denial trends and opportunities for process improvementSupporting efficient patient flow and appropriate level-of-care placementEnsuring accurate and timely documentation to support reimbursementWhat We're Looking ForGraduate of an accredited School of Nursing (RN required)Current Illinois RN licenseCurrent BLS certification requiredMinimum 5 years of acute care clinical nursing experience requiredExperience in case management, discharge planning, utilization review, or appeals preferredFamiliarity with InterQual and/or Milliman criteria preferredIdeal CandidateThis role is a great fit if you:Have strong critical thinking and clinical judgment skillsEnjoy reviewing clinical documentation and problem-solvingAre detail-oriented and comfortable working with payer guidelinesThrive in a structured, policy-driven environmentWant to transition out of bedside nursing into a more administrative clinical roleWhy Join Gateway?Competitive pay: $32.00–$48.00/hrComprehensive medical, dental, and vision insurancePaid vacation and holiday timeRetirement plan with employer matchStable weekday schedule (no nights or weekends, if applicable you can insert)Supportive case management and interdisciplinary team environmentOpportunity to directly impact quality metrics and hospital performanceLocationGateway Regional Medical Center2100 Madison AveGranite City, IL 62040CompensationCompensation is based on education, experience, certifications, and relevant skills. Final offers are determined through our compensation review process to ensure fairness and internal equity.Join a team where your clinical expertise helps ensure patients receive the right level of care at the right time-while supporting quality, compliance, and patient outcomes. Apply today.

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