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Manager Interqual Jobs in Tennessee (NOW HIRING)

Case Manager Nurse

Smyrna, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred) Benefits TriStar StoneCrest Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

Case Manager Nurse

Smyrna, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred) Benefits TriStar StoneCrest Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

Case Manager Nurse

Smyrna, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred) Benefits TriStar StoneCrest Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

Case Manager RN

Lebanon, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred)    Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

RN Case Manager

Murfreesboro, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred)  Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

RN Case Manager

Nashville, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred) Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans ...

RN Case Manager

Nashville, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred) Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans ...

Case Manager RN

Franklin, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred)    Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

Case Manager Nurse

Smyrna, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred) Benefits TriStar StoneCrest Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

RN Case Manager

Nashville, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred) Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans ...

Posted today

Case Manager RN

Lebanon, TN

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred) Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans ...

Case Manager RN

Franklin, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred)    Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

RN Case Manager

Franklin, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred)  Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

Case Manager RN

Nashville, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience (preferred)    Benefits TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available ...

Showing results 21-40

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 Tennessee?

The most popular types of Interqual jobs in Tennessee are:

Full-time, Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago


Job description

Introduction

Are you ready to manage in a new era as a Case Management Manager where building a healthier tomorrow is more than a job? Our TriStar Skyline Medical Center team is committed to partnership, innovation, legacy and improving more lives in more ways. Share your resume today.

Benefits

TriStar Skyline Medical Center offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

  • Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
  • Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
  • Free counseling services and resources for emotional, physical and financial wellbeing
  • 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  • Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  • Family support through fertility and family building benefits with Progyny and adoption assistance.
  • Referral services for child, elder and pet care, home and auto repair, event planning and more
  • Consumer discounts through Abenity and Consumer Discounts
  • Retirement readiness, rollover assistance services and preferred banking partnerships
  • Education assistance (tuition, student loan, certification support, dependent scholarships)
  • Colleague recognition program
  • Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  • Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Our teams are dedicated to improving human life. Each year about five percent of all U.S. hospital services happen at an HCA Healthcare facility. Be an impact as a Case Management Manager where your passion for leading and creativity are valued? We want your knowledge and expertise!

Job Summary and Qualifications

The Manager of Case Management Services is responsible for promoting patient-centered care by coordinating all aspects of hospital-based case management for their assigned area of responsibility in alignment with the goals of the department.

What you will do in this role:

  • Serve as a role model and functions as a clinical resource for staff.
  • Supervise and facilitate development of staff and oversees the day-to-day tasks/activities in the department.
  • Ensure staff are competent in the use of InterQual to progress the plan of care.
  • Work collaboratively and maintain active communication with physicians, nurses, and other members of the interdisciplinary care team to effect timely, appropriate patient management.
  • Monitor the quality of CM interactions with patients, families, physicians, and the multidisciplinary team by regularly shadowing staff to ensure clear understanding and adherence to department processes.
  • Monitor quality of documentation and assessments by regularly auditing the case managers’ documentation.
  • Participate in clinical performance improvement activities. Communicate effectively with patients, family, medical staff, care team members, students, supervisors, and outside contacts.
  • Assume responsibility for scheduling, staffing, education, and competencies of department.
  • Complete daily, weekly and monthly reports as assigned by the Director of Case Management.
  • Seek ways to control costs without compromising patient safety, quality of care, or the services delivered.
  • Adhere to established policy and procedure and standards of care; escalates issues promptly through the established chain of command.
  • Demonstrate knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives.
  • Serve as an advocate for patient's rights, needs, and values; ensure that patients’ ethnic, cultural, or religious values, beliefs, preferences, and needs are considered and aligned.

What qualifications you will need:

  • Associate’s Degree in Nursing or Nursing Diploma required; Bachelor's Degree in Nursing preferred.
  • Current licensure as a Registered Nurse (RN) in the state of Tennessee or compact state required.
  • 3-5 years of clinical nursing experience required.
  • 2 years of supervisory or management experience preferred.
  • InterQual experience preferred.
  • Certification in Case Management and/or InterQual or IQCI preferred.

TriStar Skyline Medical Center is a 350+ bed facility. We are Tennessee's first comprehensive stroke center and a national leader in neuroscience. In addition, we are equipped with 3 helipads, new ICU and Medical/Surgical floors, and burn care services. We offer a CARF accredited Inpatient Rehabilitation program and are a state-designated Level I Trauma Center. As an Accredited Chest Pain Center with PCI, TriStar Skyline is a leading provider of emergency heart care.


"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.

If this is the kind of dynamic growth opportunity that compels you, apply for the Case Management Manager role. We are interviewing - Apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.