Interviewing for CQI/CM Position - Have ???s

[Ginger35]

Recently, I interviewed for a quality improvement position. One of the requirements for this position was a history working as a case manager.

I have a total of 3 years Case Management experience - 2 years hospital based and one year telephonic / independent long - term case management working out of my home office. Then, I went back to the bedside in the ER because the company that I was working for as a CM was acquired by another company that hired their own case managers in house.

I haven't worked as a case manager in over 1 1/2 years so I am a little rusty.

Anyways, during my stent working as a case manager performing utilization review - it seemed to me that it was usually pretty obvious when a patient met "intensity of service" for their hospital stay. I usually referred to Interqual as a "reference" when I was running into problems or felt like I was missing information putting a plan of care puzzle together - especially, if there were multiple co-morbidities involved.

Most of my reviews were handwritten and then either called in to the insurance company or faxed.

I guess what I am trying to get at here is that during my interview, the director of this deptartment seemed to have an expectation that I am "fluent" with Interqual or have it "memorized".

My question is: When doing reviews, how is Interqual utilized in your department??? Do you all have this book's guidelines memorized? OR Do you use it as a reference? How are reviews done in your facility?

Confused,

Ginger

[Ginger's Mom, MSN, RN]

Interqual has software as well as a manual. Not all hospitals use Interqual. Alex

[ARnurse69]

I have found that, after awhile, you learn to recognize when a pt is meeting the criteria. I don't carry my Interqual around chart to chart like when I first started. If I question it, then I will refer to the book. The criteria does change some, too, from year to year.