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From Home Interqual Jobs (NOW HIRING)

Humana, Inc.

Medical Director - Claims

Experience with national guidelines such as MCG ® or InterQual * Internal Medicine, Family ... Associates who live and work from Home in the state of California, Illinois, Montana, or South ...

InnovaCare

Registered Nurse Care Manager

Lakeland, FL · Hybrid

Utilizes Electronic Medical Record (EMR), Excel, and InterQual daily * Follows up on escalations and documents accurately * Assists with required paperwork from hospitals. SNFs. LTAC, Home health

Lancesoft

Registered Nurse

Detroit, MI · On-site +1

$30 - $35/hr

... from a post-acute care setting to a lower level of care. * Should have experience with InterQual ... Two to four years of clinical experience which may include post-acute care, home care, acute ...

Prime Healthcare

RN Case Manager

Gadsden, AL

An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Knowledge of Milliman Criteria and InterQual Criteria Full benefits at Prime Healthcare: #LI-MP1 ...

Dane Street, LLC

Quality Analyst (Remote, LPN Required)

$45K - $70K/yr

... InterQual, or health plan specific guidelines/criteria). * Examine and evaluate patient records to ... WORK FROM HOME TECHNICAL REQUIREMENTS: Supply and support their own internet services. Maintaining ...

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From Home Interqual information

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How much do from home interqual jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for from home interqual in the United States is $36.28, according to ZipRecruiter salary data. Most workers in this role earn between $29.81 and $38.22 per hour, depending on experience, location, and employer.

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 key skills and qualifications needed to thrive as a Remote InterQual Reviewer, and why are they important?

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 remote 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 a Work 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.
More about From Home Interqual jobs
What cities are hiring for From Home Interqual jobs? Cities with the most From Home Interqual job openings:
What are the most commonly searched types of Interqual jobs? The most popular types of Interqual jobs are:
What states have the most From Home Interqual jobs? States with the most job openings for From Home Interqual jobs include:
What job categories do people searching From Home Interqual jobs look for? The top searched job categories for From Home Interqual jobs are:
From Home Interqual jobs near you
Infographic showing various From Home Interqual job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $75,459 per year, or $36.3 per hour.
RN - Case Manager - Weekends

RN - Case Manager - Weekends

Ephraim McDowell Health

Danville, KY • On-site

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

JOB SUMMARY:
Manages and monitors care for an assigned patient population and provides clinical and educational support to ensure that quality and cost-effective care is provided. Collaborates with patients by assessing, facilitating, planning and advocating for health needs on an individual basis. Assist in development, analysis and evaluation of Evidence Based Medicine, in cooperation with other hospital personnel, provides appropriate and timely discharge planning with referrals to Social Services as indicated. Exhibits the F.I.R.S.T. values (Friendliness, Innovation, Respect, Service and Trust).
ESSENTIAL FUNCTIONS, DUTIES AND RESPONSIBILITIES:
  • Evaluates appropriateness of nursing, medical and ancillary care of all assigned patients to decrease unnecessary tests/procedures and days admitted to the hospital: Facilitates the health delivery process to focus on the best practices based on Evidence Based Medicine in order to minimize unnecessary steps in the delivery of care.
  • Evaluates daily assigned patient's status and progress toward reaching goals in the plan of care (POC) and makes adjustments in care/services to enhance positive outcomes and improve average length of stay (ALOS).
  • Daily communication with Physicians acting as liaison between all care disciplines and other consulting physicians to facilitate and expedite all necessary treatment in order to decrease Physician ALOS.
  • Appropriately assign the status of inpatient versus observation based on InterQual criteria from day one of admission. Communicate with Executive Health Resources (EHR) physician adviser when unable to qualify patient as inpatient based on Interqual criteria.
  • Reviews and develops as assigned departmental policies and procedures to reflect current practices in case management.
  • Makes daily rounds with physicians on assigned unit and meets with Hospitalist Group to discuss POC and discharge disposition.
  • Meets daily with Charge Nurse to discuss and identify barriers to discharge for assigned patients.
  • Demonstrate competency yearly with a score of >90% on Interqual testing.
  • Utilize Interqual guidelines and criteria to perform review of each assigned patient's activities assuring proper utilization of Organizational services based on Medicare guidelines. Review assigned inpatient medical records to qualify for admission, and continued stay based on medical necessity. Maintains documentation of such reviews daily.
  • Utilizes and documents Physician Adviser referrals made appropriately. Trends results of Physician Adviser review and outcomes. Updates log of communication and submits to the Director quarterly.
  • Collects Potential Avoidable Day (PAD) variances related to timeliness of services, results of services and patient/family compliance/cooperation and documents appropriately to be submitted to the director quarterly.
  • Identifies Core Measure patients upon daily reviews and documents in Meditech.
  • Represents Case Management with Performance improvement groups monthly or as necessary to monitor and improve core measures. Development of policies based on Evidence Based Medicine to improve core measure outcomes and increase dashboard percentages.
  • Promotes communication between all disciplines, patients, families, physicians, and external agencies through accurate and timely documentation.
  • Decreases % of physician complaints regarding timeliness of consults for Case Management with accurate and timely documentation and communication with said physician.
  • Adheres to safety and disaster drills.
  • Preforms department safety checks as assigned, completed monthly.
  • Maintains patient confidentiality of identification and information by adhering to HIPPA guidelines.
  • Demonstrates a commitment to professional accountability and growth to maintain and expand knowledge and skills.
  • Contributes to the achievement of the mission, vision, and values of the Organization.
  • Contributes to the effective operations of the Organization by demonstrating dependability in job performance.
  • Demonstrates a commitment to incorporating the core concepts of patient family centered care into practice (dignity, respect, information sharing, and participation).
  • Demonstrates a commitment to the development and implementation of shared governance across the Organization.
  • Performs other related duties as assigned.

WORKING CONDITIONS, HAZARDS AND PHYSICAL EFFORT:
Primarily light work requiring to move or position up to 10 lbs. Long periods in a stationary position and moving around the unit. Works in a well-lighted, ventilated and air conditioned area when in the office; required to go to patient areas and other parts of the Organization for retrieval of information, patient interviews and assessment, meetings and related activities. During home visits possible exposure to disease, infection and physical strain and assault, as well as exposure to blood, body fluids, and tissue. Moderately stressful environment where department's workload must be completed within prescribed time frames using fixed staffing resources.
CONTACTS WITH OTHERS:
Nursing staff, physicians, department managers, ancillary staff, patients, families, review specialist, EHR, other case management workers, community resources/services, and referral agencies.
EQUIPMENT USED/SPECIAL SKILLS REQUIRED:
Proficient computer skills required. Preferred knowledge of the Meditech software or equivalent. Must be skilled in medical terminology and diagnosis. Utilizes communication skills with a high degree of effectiveness in working with physicians, hospital staff, consultants and review agencies.
Minimum of five (5) years' experience in a healthcare setting; ability to access, evaluate and intervene as needed in the care delivered to an assigned population; ability to effect change and be a change facilitator; knowledge of funding resources, services and clinical standards and outcomes; possess effective communication skills, both written and verbal; basic knowledge of growth, development and range of treatment needed by assigned patients.

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