Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG) preferred * Excellent critical thinking ...
UTILIZATION SPECIALIST
Hudson, 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 ...
UTILIZATION SPECIALIST
Hudson, 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 ...
UTILIZATION SPECIALIST
Hudson, 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 ...
UTILIZATION SPECIALIST
Hudson, 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 ...
Minimum 1 year experience with utilization management, case management and knowledge of InterQual and MCG OR 5 years' relevant adult clinical experience. Process improvement experience. Knowledge ...
Minimum 1 year experience with utilization management, case management and knowledge of InterQual and MCG OR 5 years' relevant adult clinical experience. Process improvement experience. Knowledge ...
UTILIZATION SPECIALIST-E.D.
Hudson, 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 ...
UTILIZATION SPECIALIST-E.D.
Hudson, 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 ...
Minimum 1 year experience with utilization management, case management and knowledge of InterQual and MCG OR 5 years' relevant adult clinical experience. Process improvement experience. Knowledge ...
Minimum 1 year experience with utilization management, case management and knowledge of InterQual and MCG OR 5 years' relevant adult clinical experience. Process improvement experience. Knowledge ...
Previous Care Management, Case Management or Utilization Management Experience preferred. * Previous experience with screening criteria (i.e., Interqual, MCG) preferred. * Excellent critical thinking ...
Previous Care Management, Case Management or Utilization Management Experience preferred. * Previous experience with screening criteria (i.e., Interqual, MCG) preferred. * Excellent critical thinking ...
Minimum 1 year experience with utilization management, case management and knowledge of InterQual and MCG OR 5 years' relevant adult clinical experience. Process improvement experience. Knowledge ...
Minimum 1 year experience with utilization management, case management and knowledge of InterQual and MCG OR 5 years' relevant adult clinical experience. Process improvement experience. Knowledge ...
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 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:
Southwest General Health Center rating
6.9
Based on 46 frontline employees who took The Breakroom Quiz
549th of 1,055 rated hospitals
Job description
Summary
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POSITION INFORMATION
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Position summary:
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The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital resources, and quality of care rendered. Accurate and efficient application of screening criteria will be applied to identify and support patients being placed in the appropriate hospital level of care via emergency, scheduled, or direct admission processes. Combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification, and education, the Utilization Specialist facilitates the quality of health care delivery in the most cost-effective manner. The Utilization Specialist must be able to demonstrate the knowledge and skills necessary to provide services appropriate to age groups according to specific chronological age, developmental age, and/or psycho-social maturity. The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patients plan of care. The Utilization Specialists responsibility is to collect data and clinical review summaries on patients concurrently for both utilization review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The Utilization Specialist will communicate with physicians, hospital staff, outside agencies such as insurance companies, and patients regarding the assigned level of care and associated resource utilization.
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MINIMUM QUALIFICATIONS
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Education:
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Graduation from an accredited School of Nursing. BSN graduate preferred.
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Required length and type of experience:-
Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
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Previous Care Management, Case Management or Utilization Management Experience preferred
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Previous experience with screening criteria (i.e. Interqual, MCG) preferred
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Excellent critical thinking and communication skills
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Strong computer skills
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Required licensure, certification or registry:-
Current licensure by Ohio State Board of Nursing.
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ACM/CCM Certification helpful
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What Southwest General Health Center employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Southwest General
Sourced by ZipRecruiter
Industry
Hospitals
Company size
1,001 - 5,000 Employees
Headquarters location
Middleburg Heights, OH, US
Year founded
1920