The Care Manager facilitates transition of care planning with an interdisciplinary healthcare team ... InterQual criteria, Preferred Why Mercy? From day one, Mercy offers outstanding benefits ...
The Care Manager facilitates transition of care planning with an interdisciplinary healthcare team ... InterQual criteria, Preferred Why Mercy? From day one, Mercy offers outstanding benefits ...
The Care Management model provides effective transition planning and length of stay oversight while ... of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers ...
The Care Management model provides effective transition planning and length of stay oversight while ... of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers ...
Good organizational, multi-tasking, and time-management skills Assets : * Degree in Clinical Informatics * Familiarity with CMS, MCG, Interqual guidelines * Comfortable in querying and analyzing data ...
Quick apply
Good organizational, multi-tasking, and time-management skills Assets : * Degree in Clinical Informatics * Familiarity with CMS, MCG, Interqual guidelines * Comfortable in querying and analyzing data ...
SSBV Medical Director - Remote
Plymouth, MN · Remote
$248K - $373K/yr
... Management experience and/or administrative leadership experience * Experience applying evidence-based level-of-care criteria (e.g., InterQual or MCG) in utilization review or payment integrity ...
SSBV Medical Director - Remote
Plymouth, MN · Remote
$248K - $373K/yr
... Management experience and/or administrative leadership experience * Experience applying evidence-based level-of-care criteria (e.g., InterQual or MCG) in utilization review or payment integrity ...
SSBV Clinical Claim Review RN
Plymouth, MN · Remote
$28.94 - $51.83/hr
A background in utilization review for an insurance company or experience in case management * Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters will ...
SSBV Clinical Claim Review RN
Plymouth, MN · Remote
$28.94 - $51.83/hr
A background in utilization review for an insurance company or experience in case management * Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters will ...
SSBV Clinical Claim Review RN
Plymouth, MN · On-site
$28.94 - $51.83/hr
A background in utilization review for an insurance company or experience in case management * Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters will ...
SSBV Clinical Claim Review RN
Plymouth, MN · On-site
$28.94 - $51.83/hr
A background in utilization review for an insurance company or experience in case management * Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters will ...
Milliman or InterQual care guidelines, preferred Knowledge/Skills/Abilities: *Strong written, verbal and listening skills *Strong analytical skills *Project management skills *Ability to research and ...
Milliman or InterQual care guidelines, preferred Knowledge/Skills/Abilities: *Strong written, verbal and listening skills *Strong analytical skills *Project management skills *Ability to research and ...
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?
| Aspect | Manager Interqual | Clinical Case Manager |
|---|---|---|
| Credentials | Typically requires nursing or healthcare management certifications | Requires nursing or social work licensure and clinical experience |
| Work Environment | Healthcare organizations, utilization review departments | Hospitals, insurance companies, community health settings |
| Primary Focus | Utilization management, policy implementation, and compliance | Patient 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 are 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 Minnesota? The most popular types of Interqual jobs in Minnesota are:
What cities in Minnesota are hiring for Manager Interqual jobs? Cities in Minnesota with the most Manager Interqual job openings:
Part-time
Medical, Dental, Vision, Retirement, PTO
Posted 6 days ago
Mercy rating
6.4
Based on 206 frontline employees who took The Breakroom Quiz
643rd of 890 rated healthcare providers
Job description
Find your calling at Mercy!The Care Manager facilitates transition of care planning with an interdisciplinary healthcare team to achieve quality outcomes, reduce costs and ensure patient safety.Position Details:
Minimum Qualifications:
Education:
Graduate of an accredited School of Nursing.
Bachelor's Degree of Science in Nursing.
Licensure:
Current License in the state of employment.
Experience:
2-3 years acute care hospital setting
Certification/Registration:
BLS (CPR) at hire date, Minimum Required, or within 90 days of hire.
Physical Requirements:
Position requires individuals to push, pull, and/or lift 50 pounds regularly.
Position requires prolonged standing and walking during each shift.
Position requires the ability to grip, reach, bend, kneel, twist, and squat to perform duties.
Preferred Qualifications:
Experience:
Care Management or Utilization Management experience.
Certification/Registration:
Certification in Case Management.
Other Skills & Knowledge:
Strong verbal and written communication and facilitation skills, Minimum Required
Strong assessment skills, time management skills, critical thinking skills, Minimum Required
Advanced computer skills, Minimum Required
Must have ability to interact effectively with a variety of people and situations at all levels of the organization, Minimum Required
Knowledge of InterQual criteria, Preferred
From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
About Mercy
Sourced by ZipRecruiter
Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service. At Mercy, we believe in careers that match the unique gifts of unique individuals - careers that not only make the most of your skills and talents, but also your heart.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Chesterfield, MO, US
Year founded
1827