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Manager Interqual Jobs in Ohio (NOW HIRING)

Premier Health

CASE MANAGER

Dayton, OH · On-site

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER

Dayton, OH · On-site

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER

Dayton, OH · On-site

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER

Dayton, OH

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER

Dayton, OH · On-site

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER - Part Time

Dayton, OH · On-site

Case Manager (RN) Dept: Integrated Care Management Program Shift: Part Time -0830-1700 / 48 Hours ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER - Part Time

Dayton, OH · On-site

Case Manager (RN) Dept: Integrated Care Management Program Shift: Part Time -0830-1700 / 48 Hours ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER - Part Time

Dayton, OH

Case Manager (RN) Dept: Integrated Care Management Program Shift: Part Time -0830-1700 / 48 Hours ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER - Part Time

Dayton, OH

Case Manager (RN) Dept: Integrated Care Management Program Shift: Part Time -0830-1700 / 48 Hours ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER SUPPORT

Middletown, OH · On-site

Dept: INTEGRATED CARE MANAGEMENT Shift/ Status: SUPPORT (PRN)/VARIED HOURS/24 HOURS PER MONTH ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER SUPPORT

Middletown, OH

Dept: INTEGRATED CARE MANAGEMENT Shift/ Status: SUPPORT (PRN)/VARIED HOURS/24 HOURS PER MONTH ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER SUPPORT

Middletown, OH · On-site

Dept: INTEGRATED CARE MANAGEMENT Shift/ Status: SUPPORT (PRN)/VARIED HOURS/24 HOURS PER MONTH ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

Premier Health

CASE MANAGER SUPPORT

Middletown, OH · On-site

Dept: INTEGRATED CARE MANAGEMENT Shift/ Status: SUPPORT (PRN)/VARIED HOURS/24 HOURS PER MONTH ... Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements ...

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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 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 Ohio? The most popular types of Interqual jobs in Ohio are:
Manager Interqual jobs near you
RN Utilization Manager

RN Utilization Manager

Talented Medical Solutions

Middleburg Heights, OH • On-site

$2.0K - $2.2K/wk

Full-time

Posted yesterday

Job description

Job Summary

RN Utilization Manager

Talented Medical Solutions

Full-time, Contract

In-Office | Middleburg Heights, OH, United States


Schedule: Full-Time 40 hours per week, 5 (8) hour shifts 8a-4:30p.

Start Date: ASAP or 12/08 - URGENT NEED

Requirements:

  • 5 years recent experience in clinical nursing 

  • Previous case management or Utilization Management experience

  • Previous experience with screening criteria Cerner, InterQual, and MCG 

  • Unencumbered RN OH License 

  • ACM/CCM certification - nice to have