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Manager Interqual Jobs in Ohio (NOW HIRING)

Prime Healthcare

RN Case Manager

East Liverpool, OH · On-site

Responsibilities Responsible for the quality and resource management of all patients that are ... Knowledge of Milliman Criteria and InterQual Criteria preferred. LI-HMI Employment Status Full Time ...

talent4health

RN - Utilization Review

Cleveland, OH · On-site

$2.2K/wk

Previous Care Management, Case Management, or Utilization Management Experience. * Experience with doing 30+ reviews a day. * Previous experience with screening criteria including Cerner, InterQual ...

Southwest General

UTILIZATION SPECIALIST

Cleveland, OH · On-site

Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...

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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 Ohio?

The most popular types of Interqual jobs in Ohio are:

Manager Interqual jobs near you

RN / Utilization Review

TPF Nursing Agency

Middleburg Heights, OH • On-site

Other

Medical, Dental, Vision, Retirement

Re-posted 9 days ago

Job description

TPF Nursing welcomes you to our job board. Please review the job opportunity below:
Client: Southwest General Hospital Health Center
Location: Middleburg Heights OH
Shift: 5 x 8 Days
Start / End: Mon 7/20/26 - 10/17/26
Duration: 13 Weeks
Highlights

  • Shift: 8am-4:30pm
  • Minimum of five (5) years recent RN experience
  • Previous Case Management or Utilization Management Experience required
  • Previous experience with screening criteria Cerner, InterQual, and MCG Criteria, Standardized Templates required
  • Full-Time 40 hours per week, 5 (8) hour shifts 8a-4:30p, as well as every 3rd weekend
  • Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
  • Previous Care Management, Case Management or Utilization Management Experience
  • Experience with doing 30+ reviews a day
  • Previous experience with screening criteria including Cerner, InterQual, and MCG is required
  • Excellent critical thinking and communication skills
  • Strong computer skills
  • Current licensure by Ohio State Board of Nursing
  • ACM/CCM Certification helpful
  • Is candidate local to facility? Highly desired
If you have any questions, please feel free to call us directly at 212-219-2677 and ask for a recruiter. We encourage applicants and staff to ask questions, discuss potential / existing assignments, keep us informed about their needs and how we might help. Most clinical contracts are 13 weeks with a didactic and clinical orientation. These clinical opportunities are updated on a regular basis, so please come back if you don't see an opportunity that suits you.
Benefits available through agency:
  • Health Insurance
  • Dental Insurance
  • Vision Insurance
  • Safe Harbor and Retirement Savings Plan -401k
  • Weekly Pay
  • 24/7 On Call
  • Holiday OT
  • Sick Pay
  • FMLA
  • Joint Commission Certified

LT # 22836

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