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Manager Interqual Jobs in Illinois (NOW HIRING)

Prime Healthcare

Case Manager

Joliet, IL · On-site

$43/hr

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 Hospital - Elgin

Case Manager RN

Elgin, IL · On-site

$43/hr

Responsibilities Responsible for the quality and resource management of all patients that are ... and InterQual Criteria preferred. 7. Current BCLS certificate, preferred Pay Transparency Saint ...

Prime Healthcare

Case Manager RN

Elgin, IL · On-site

$43/hr

Responsible for the quality and resource management of all patients that are admitted to the ... and InterQual Criteria preferred. 7. Current BCLS certificate, preferred Saint Joseph Hospital ...

Prime Healthcare

Case Manager

Joliet, IL · On-site

$35.35 - $53.58/hr

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 ...

Prime Healthcare

Case Manager

Joliet, IL · On-site

$60 - $80/hr

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 ...

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Manager Interqual information

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.

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 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 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 most commonly searched types of Interqual jobs in Illinois?

The most popular types of Interqual jobs in Illinois are:

Manager Interqual jobs near you

Case Manager

Prime Healthcare

Joliet, IL • On-site

$43/hr

Per diem

Re-posted 2 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 289 frontline employees who took The Breakroom Quiz

648th of 898 rated healthcare providers

Job description

• Schedule: Days, 7:30a-4p, Per Diem (as needed, minimum 4 shifts per month)

• Facility: Prime Healthcare Saint Joseph Medical Center

• Location: Joliet, IL 60435


Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management.  Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care.  The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness. 


EDUCATION, EXPERIENCE, TRAINING

Required Qualifications:

1. Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
2. At least one year experience in case management, discharge planning or nursing management
3. Experience and knowledge in basic to intermediate computer skills.
Preferred Qualifications:

4. Five years of acute care nursing experience.  preferred
5. CCM or obtained within 1year
6. Knowledge of Milliman Criteria and InterQual Criteria preferred.
7. Current BCLS certificate, preferred

#LI-GM1


Saint Joseph Medical Center - Joliet offers competitive compensation and a reasonable compensation estimate for this role is $43.00 to $43.00. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.


Per Diem
Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

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