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Manager Interqual Jobs in Illinois (NOW HIRING)

NorthShore

RN Care Manager

Evanston, IL · On-site

$40.45 - $62.70/hr

Position: RN Care Manager * Location: Evanston, IL * Full Time: 40 hours/week * Hours: Monday ... Knowledge of InterQual or MCG criteria is preferred. What you will do: * Facilitates payor ...

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

RN Care Manager

Evanston, IL · On-site

$40.45 - $62.70/hr

Position: RN Care Manager * Location: Evanston, IL * Full Time: 40 hours/week * Hours: Monday ... Knowledge of InterQual or MCG criteria is preferred. What you will do: * Facilitates payor ...

Endeavor Health

RN Care Manager

Evanston, IL

$40.45 - $62.70/hr

Position: RN Care Manager * Location: Evanston, IL * Full Time: 40 hours/week * Hours: Monday ... Knowledge of InterQual or MCG criteria is preferred. What you will do: * Facilitates payor ...

Endeavor Health Services

RN Care Manager

Evanston, IL · On-site

$40.45 - $62.70/hr

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 ...

North Shore Inc

RN Care Manager

Evanston, IL · On-site

$40.45 - $62.70/hr

Position: RN Care Manager * Location: Evanston, IL * Full Time: 40 hours/week * Hours: Monday ... Knowledge of InterQual or MCG criteria is preferred. What you will do: * Facilitates payor ...

Med-Metrix

Physician Advisor - Remote

Chicago, IL · On-site

$150 - $200/hr

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

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

Prime Healthcare

Director of Case Management

Chicago, IL · On-site

$100K - $135K/yr

Case Management Schedule : Full-Time, Days, Exempt Facility: Saint Mary of Nazareth Hospital ... InterQual Criteria preferred. #LI-CC2 Saint Mary of Nazareth Hospital offers competitive ...

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Showing results 21-40

All JobsInterqual JobsManager Interqual JobsManager Interqual Jobs in Illinois

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 Registered Nurse

Olympia Fields Hospital

Olympia Fields, IL • On-site

$73K - $111K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 7 days ago

Key responsibilities

  • Perform a holistic and comprehensive admission and concurrent review of the medical record to assess medical necessity, intensity of service, and severity of illness.

  • Manage the quality and resource utilization for all admitted patients from admission through the continuum of care.

  • Promote cost containment and facilitate the integration of healthcare providers to ensure seamless delivery of care.

Job description

OverviewDepartment: OFIL Social WorkShift: Full-Time, DaysFacility: Olympia Fields Hospital Location: 20201 South Crawford Ave, Olympia Fields, IL 60461Responsibilities

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 insure 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.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

1. Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license

2. Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.

3. Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.

4. Current BCLS certificate, preferred.

5. Knowledge of Milliman Criteria and InterQual Criteria preferred.

6. Experience and knowledge in basic to intermediate computer skills.

Pay Transparency

Olympia Fields Hospital offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $73,528 to $111,446.40 on an annualized basis. 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.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Employment StatusFull TimeShiftDaysEqual Employment Opportunity

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

Employment Type: FULL_TIME

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