Case Managers enhance the continuity of care and cost effectiveness by integrating the functions of ... Utilizes Milliman/Interqual Care Guidelines to track impact and variance. * Discharge Planning:
Case Managers enhance the continuity of care and cost effectiveness by integrating the functions of ... Utilizes Milliman/Interqual Care Guidelines to track impact and variance. * Discharge Planning:
Case Managers enhance the continuity of care and cost effectiveness by integrating the functions of ... Utilizes Milliman/Interqual Care Guidelines to track impact and variance. * Discharge Planning:
Case Managers enhance the continuity of care and cost effectiveness by integrating the functions of ... Utilizes Milliman/Interqual Care Guidelines to track impact and variance. * Discharge Planning:
Utilizes Interqual Criteria for screening transfers into the facility. Must possess a thorough ... JOB KNOWLEDGE/EXPERIENCE : • Knowledge in the areas of case management and utilization management ...
Utilizes Interqual Criteria for screening transfers into the facility. Must possess a thorough ... JOB KNOWLEDGE/EXPERIENCE : • Knowledge in the areas of case management and utilization management ...
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
San Antonio, TX · On-site
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
San Antonio, TX · On-site
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
San Antonio, TX · On-site
$30.50 - $51/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
San Antonio, TX · On-site
$30.50 - $51/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
San Antonio, TX · On-site
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
San Antonio, TX · On-site
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
$30.50 - $47/hr
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
San Antonio, TX · On-site
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse Case Manager - CFHP
San Antonio, TX · On-site
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred ... Management Society, is preferred.
Nurse, Concurrent Review
Houston, TX · On-site
... management experience, preferred Experience with InterQual or similar evidence-based clinical decision support criteria, preferred Willingness to complete and maintain InterQual certification and ...
Nurse, Concurrent Review
Houston, TX · On-site
... management experience, preferred Experience with InterQual or similar evidence-based clinical decision support criteria, preferred Willingness to complete and maintain InterQual certification and ...
Nurse, Concurrent Review
Houston, TX · On-site
... case management experience, preferred • Experience with InterQual or similar evidence-based clinical decision support criteria, preferred • Willingness to complete and maintain InterQual ...
Quick apply
Nurse, Concurrent Review
Houston, TX · On-site
... case management experience, preferred • Experience with InterQual or similar evidence-based clinical decision support criteria, preferred • Willingness to complete and maintain InterQual ...
Nurse, Concurrent Review
Houston, TX · On-site +1
... case management experience, preferred • Experience with InterQual or similar evidence-based clinical decision support criteria, preferred • Willingness to complete and maintain InterQual ...
Nurse, Concurrent Review
Houston, TX · On-site +1
... case management experience, preferred • Experience with InterQual or similar evidence-based clinical decision support criteria, preferred • Willingness to complete and maintain InterQual ...
RN Case Manager
Dallas, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
RN Case Manager
Dallas, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
AUSTIN TX Utilization Review RN
Austin, TX · On-site
$35 - $40/hr
Collaborate with physicians, case managers, and healthcare teams to coordinate patient care plans * Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review decisions
Quick apply
AUSTIN TX Utilization Review RN
Austin, TX · On-site
$35 - $40/hr
Collaborate with physicians, case managers, and healthcare teams to coordinate patient care plans * Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review decisions
RN Case Manager
Allen, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
RN Case Manager
Allen, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
RN Case Manager
Bedford, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
RN Case Manager
Bedford, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
RN Case Manager
Carrollton, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
RN Case Manager
Carrollton, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
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.
Full-time
Posted 10 days ago
CHRISTUS Health rating
6.7
Based on 525 frontline employees who took The Breakroom Quiz
532nd of 890 rated healthcare providers
Job description
Summary:
This position provides expertise and leadership to insure effective resource management for patient care delivery (Conditions of Participation COP 482.30). Case Managers enhance the continuity of care and cost effectiveness by integrating the functions of case management, resource management, clinical documentation management, and discharge planning (Conditions of Participation COP 482.43). Daily and concurrently involved in the management of inpatient and observation patients by comprehensive assessment, planning, interventions, and evaluations of appropriate level of care. Collaborates with other members of the health care team to ensure the above according to the mission of CHRISTUS Santa Rosa Health Care.
Responsibilities:
Requirements:
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
This position provides expertise and leadership to insure effective resource management for patient care delivery (Conditions of Participation COP 482.30). Case Managers enhance the continuity of care and cost effectiveness by integrating the functions of case management, resource management, clinical documentation management, and discharge planning (Conditions of Participation COP 482.43). Daily and concurrently involved in the management of inpatient and observation patients by comprehensive assessment, planning, interventions, and evaluations of appropriate level of care. Collaborates with other members of the health care team to ensure the above according to the mission of CHRISTUS Santa Rosa Health Care.
Responsibilities:
- Key driver of throughput process by safe discharge plan
- Daily monitors LOS compared to GMLOS on each patient for reduction in opportunity days to reach LOS ratioLOS: Impacts Medicare GMLOS by managing per Milliman/Interqual Care Guidelines.
- Resource/Utilization Management/appropriateness: Assess assigned patient population for medical necessity, level of care and appropriateness of setting and services. Utilizes Milliman/Interqual Care Guidelines to track impact and variance.
- Discharge Planning: Collaborates with Social Worker proactively - arranges to meet facilities' target Discharge Time. Initiates NaviHealth search for PAN refferrals.
- Proactively uses 3M report which assigns working MS/APR DRG in MIDAS daily, and queries, communicates and collaborates with nursing, physicians, and other healthcare professionals daily related to length of stay (LOS).
- Adheres to MCG process for documentation per training
- Documents delays of care and readmits appropriately and timely to develop potential trends and improved interventions.
- Payer Initiatives: Reconciles services available and rendered with patient benefit allowances to assure reimbursement and minimize financial losses for patient and hospital.
- Proactively refers cases to physician adviser for P2P, medical necessity review, and denail avoidance.
- Demonstrates and maintains current knowledge of regulatory agencies' relative to work process for compliance, i.e. IMM, Code 44
- Timely communication with Admitting for status changes to ensure proper payer notification.
- Attends and actively participates in interdisciplinary patient care rounds on a daily basis and works with the health care team to collaboratively formulate appropriate and realistic discharge plans.
- Guest Relations/Communications: Demonstrates positive role modeling of customer relations (customers include patient, physicians, other health care team members, payers, etc.). Uses AIDET and KWKT appropriately.
- Quality/Outcomes Management: Identify and assist outcomes management process by referring and reporting variances in standards of care for identified patient populations.
- Change Management: Acts as a catalyst for change in the organization; responds to change with flexibility and adaptability to overcome organizational resistance and inertia; demonstrates the ability to focus and energize associates to work together for change; gains maximum support form others for new initiatives.
- Shaping the Organization: Devises systems and processes which improve the overall functioning of the organization; ensures that the organization's systems, processes and people are integrated to achieve the mission in the most efficient and effective manner.
- Achieving Results: Demonstrates the confidence, drive and ability to face and overcome challenges and obstacles to achieve organizational goals.
- Enhancing Clinical Outcomes: Works to improve the healthcare process in general and devises and implements strategies specifically directed at improving clinical outcomes.
- Utilizes licensed evidenced-based tools (MCG / Interqual) to analyze and identify trends/patterns of performance through variance reporting to improve quality, satisfaction, and decrease cost variation.
- Age/cultural specific implications: Appropriately adapts assigned assessment, treatment and/or service methods to accommodate the unique physical, psychological, cultural, age-specific and other developmental needs of each member served.
- Core Values: Demonstrates adherence to the CORE values of Santa Rosa Health Care.
- Some weekend work and work after normal business hours may be required, as needed, to meet the needs of the facility and our patients.
- Performs other duties as directed.
Requirements:
- Graduate of an accredited school of Nursing required. BSN preferred.
- Proficient word processing skills in a Windows environment required.
- Ability to analyze and create reports and presentations via software applications.
- Familiarity with MIDAS and Meditech systems preferred. Bilingual (English/Spanish)preferred.
- A minimum of 5 years in clinical practice for population to be served is required.
- Case Management/Resource Management and discharge planning experience preferred.
- Milliman (MCG) Guideline and Interqual criteria experience highly preferred.
- Currently licensed as RN in the State of Texas required
- CPR optional
- Certification in Case Management preferred
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
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About CHRISTUS Health
Sourced by ZipRecruiter
CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.
Industry
Outpatient health care
Company size
1,001 - 5,000 Employees
Headquarters location
Irving, TX, US
Year founded
1999