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From Home Interqual Jobs in Michigan (NOW HIRING)

Corewell Health

RN Care Coordinator

Northville, MI · On-site

May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved ... transition from hospital setting to the appropriate alternative level of care. Seeks out ...

Corewell Health

RN Care Coordinator

Farmington, MI · On-site

May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved ... CRT-At least one Certification from preferred list - UNKNOWN Unknown Upon Hire required * Basic ...

Spectrum Health

RN Care Coordinator

Trenton, MI · On-site

May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Spectrum Health

RN Care Coordinator

Dearborn, MI

May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

TH Medical

Clinical Liaison

Detroit, MI · On-site

$64K - $86K/yr

Access location points typically include acute care hospitals, post-acute venues, clinic, or home ... Coordinates the gathering of pertinent patient information on all referred patients from various ...

DMC Sinai-Grace Hospital

Clinical Liaison

Detroit, MI · On-site

$59K - $80K/yr

Access location points typically include acute care hospitals, post-acute venues, clinic, or home ... Coordinates the gathering of pertinent patient information on all referred patients from various ...

Corewell Health

RN Care Coordinator

Dearborn, MI · On-site

May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Corewell Health

RN Care Coordinator

Trenton, MI · On-site

May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

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All JobsInterqual JobsFrom Home Interqual JobsFrom Home Interqual Jobs in Michigan

From Home Interqual information

What is a from home InterQual reviewer?

A Work From Home InterQual reviewer is a healthcare professional, often a nurse or clinical reviewer, who evaluates medical cases remotely using the InterQual criteria. InterQual is a set of evidence-based clinical guidelines used to determine the medical necessity and appropriateness of healthcare services. These reviewers assess patient records, treatment plans, and hospital admissions to ensure they meet established standards, helping healthcare organizations with utilization management and compliance. Working from home allows these professionals to perform their duties remotely, often using secure digital platforms.

What are the key skills and qualifications needed to thrive as a from home InterQual reviewer?

To thrive as a Remote InterQual Reviewer, you need a background in nursing or healthcare, strong clinical judgment, and experience with utilization review processes. Familiarity with InterQual criteria software, electronic medical records (EMRs), and relevant certifications such as RN or LPN/LVN are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for this role. These competencies ensure accurate clinical reviews, regulatory compliance, and clear collaboration with healthcare teams in a remote setting.

What are some common challenges faced by from home InterQual reviewers, and how can they be managed effectively?

Remote InterQual reviewers often face challenges such as maintaining consistent communication with healthcare teams, interpreting clinical documentation without direct patient contact, and managing distractions in a home environment. To address these, it’s important to establish a dedicated workspace, use secure collaboration tools for real-time updates, and participate in regular team meetings. Staying organized and following standard review protocols helps ensure accuracy and efficiency while working independently from home.

What is the difference between From Home Interqual vs From Home Utilization Review Nurse?

AspectFrom Home InterqualFrom Home Utilization Review Nurse
CertificationsInterqual certification, RN licenseRN license, Utilization Review certification
Work EnvironmentRemote, healthcare settingsRemote, healthcare facilities or insurance companies
Industry UsageHealthcare, insurance, case managementHealthcare, insurance, case management
Primary FocusApplying Interqual criteria for patient care decisionsAssessing medical necessity for insurance coverage

From Home Interqual professionals focus on applying Interqual criteria to evaluate patient care, while From Home Utilization Review Nurses assess medical necessity for insurance coverage. Both roles require RN licensure and healthcare knowledge, but Interqual specialists emphasize criteria application, whereas Utilization Review Nurses focus on coverage decisions.

What are the most commonly searched types of Interqual jobs in Michigan?

The most popular types of Interqual jobs in Michigan are:

What are popular job titles related to From Home Interqual jobs in Michigan?

For From Home Interqual jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching From Home Interqual jobs in Michigan look for?

The top searched job categories for From Home Interqual jobs in Michigan are:

What cities in Michigan are hiring for From Home Interqual jobs?

Cities in Michigan with the most From Home Interqual job openings:

From Home Interqual jobs near you
Infographic showing various From Home Interqual job openings in Michigan as of August 2026, with employment types broken down into 50% Part Time, and 50% Contract. Highlights an 100% In-person job distribution.

Registered Nurse-Review Analys

EPITEC

Detroit, MI • On-site

Other

Medical

Posted 5 days ago

Job description

  • Location: Detroit, Michigan
  • Type: Contract
  • Job #105434
Registered Nurse (RN) Clinical Training & Quality Specialist
? Remote / Work From Home
? Michigan RN License Required
About the Opportunity
We are seeking an experienced Registered Nurse (RN) to support clinical quality, training, and utilization management initiatives in a fully remote environment. This role is responsible for staff education, quality reviews, audit coordination, training program development, and supporting accreditation and compliance efforts.
The ideal candidate will have a strong background in Care Management, Utilization Management, InterQual/MCG criteria, clinical training, and quality improvement.
Responsibilities
  • Educate staff on managed care programs, processes, systems, and departmental procedures.
  • Conduct quality reviews and audits of clinical cases.
  • Develop, maintain, and update training materials, manuals, and educational resources.
  • Mentor and support new hires throughout the onboarding and training process.
  • Collaborate with leadership and subject matter experts to identify training needs and resources.
  • Educate internal staff and external provider facilities on clinical policies, InterQual criteria, and departmental processes.
  • Create and deliver training programs and educational packages.
  • Participate in the development, testing, and implementation of new programs and systems.
  • Analyze performance data and provide recommendations for improvement.
  • Coordinate training logistics, class registration, scheduling, attendance tracking, and system access for new employees.
  • Perform and coordinate internal and external audits.
  • Support accreditation and regulatory compliance initiatives.
  • Serve as a change champion by supporting new processes, systems, and tools.
  • Travel occasionally as needed.
Required Qualifications
  • Nursing Diploma or Associate Degree in Nursing required.
  • Current, unrestricted Michigan Registered Nurse (RN) license required.
  • Minimum 5 years of experience in healthcare-related fields.
  • 3 to 5 years of experience in Care Management and/or Utilization Management.
  • Strong knowledge of utilization management processes and InterQual and/or MCG criteria.
  • Experience conducting clinical quality reviews and audits.
  • Excellent written, verbal, analytical, and organizational skills.
  • Ability to work independently and manage multiple priorities in a remote environment.
Preferred Qualifications
  • Bachelor's Degree in Nursing (BSN) or related field.
  • Case Management (CM) Certification.
  • Experience with clinical training and staff development.
Technical Skills & Knowledge
  • Microsoft Office Suite (Excel, Word, Teams)
  • SharePoint
  • Care Advance
  • Virtual Desktop Applications (VDA)
  • Electronic Health Records
  • ICD-10 and CPT Coding
  • CMS, NCQA, HIPAA, and other healthcare regulatory requirements
  • Clinical assessment and intervention methodologies
Why Apply?
  • Fully remote opportunity
  • Meaningful impact on clinical quality and staff development
  • Collaborative healthcare environment
  • Opportunity to contribute to training, compliance, and process improvement initiatives

Apply today if you are a Michigan-licensed RN with experience in Care Management, Utilization Management, training, and quality improvement.
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