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From Home Interqual Jobs (NOW HIRING)

Wesley Medical Center

RN Case Manager

Wichita, KS · On-site

Bachelor's degree from an accredited institution is preferred * 2 years of case management ... InterQual experience is preferred Benefits Wesley Medical Center, offers a total rewards package ...

Wesley Medical Center

RN Case Manager PRN

Wichita, KS · On-site

Bachelor's degree from an accredited institution is preferred * 2 years of case management ... InterQual experience is preferred Benefits Wesley Medical Center, offers a total rewards package ...

Wesley Medical Center

RN Case Manager

Wichita, KS · On-site

Bachelor's degree from an accredited institution is preferred * 2 years of case management ... InterQual experience is preferred Benefits Wesley Medical Center, offers a total rewards package ...

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How much do from home interqual jobs pay per hour?

As of Jul 15, 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.
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From Home Interqual jobs near you
Infographic showing various From Home Interqual job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 71% Full Time, 23% Part Time, 1% Temporary, and 4% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $75,459 per year, or $36.3 per hour.
RN, Care Manager (Emergency Dept) - Per Diem, Day Shift

RN, Care Manager (Emergency Dept) - Per Diem, Day Shift

Adventist Health

Los Angeles, CA • On-site

Other

Re-posted 12 days ago

Adventist Health rating

7.8

Company rating: 7.8 out of 10

Based on 241 frontline employees who took The Breakroom Quiz

132nd of 885 rated healthcare providers

Job description

Centered in the heart of Boyle Heights, Adventist Health White Memorial is one of the area's leading healthcare providers since 1913. We are comprised of a 353-bed hospital, three medical office buildings, residency programs, comprehensive cancer care and a vast scope of services located in the Los Angeles area. In 2019, Adventist Health White Memorial was recognized with the Malcolm Baldrige National Quality Award, the nation's highest presidential honor for performance excellence. We are proud to promote wellness in the community at the local farmers market and through our community resource center with services for seniors and Spanish-speakers. Los Angeles is known for its art, rich culture, numerous sports teams and world-renowned dining. There is something for everyone in this culturally diverse city.

Job Summary:

Establishes, coordinates, and maintains the process to increase patient through-put to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the Emergency Department (ED). Collaborates with the patient/family, multidisciplinary team, physicians, community resources and payers to ensure the patient's progress and level of care is appropriately determined for the emergency episode of care and for the inpatient encounter to ensure that care is performed and facilitated in an efficient and cost-effective manner. Uses well developed knowledge and skills in patient status determination (InterQual Criteria), in the assessment and care management of patients and families within the ED, inpatient and outpatient settings. Practices patient/family assessment and management, resource management, identifying patients appropriate for inpatient admission, observation, or outpatient status, care facilitation, discharge planning with referral to all levels of care, and other related duties specific to the defined patient population. Collaborates with other case managers, social work staff, the access center, admissions, and other physician and administrative leadership staff within the ED, the care management department and both the inpatient and outpatient settings. Uses knowledge of pathophysiology, pharmacology, and clinical care processes to participate with other clinical staff and physicians in the development of clinical practice guidelines and physician order sets for the purpose of improving quality of care, changing practice, and reducing costs.

Job Requirements:

Education and Work Experience:

  • Bachelor's Degree in Nursing (BSN): Preferred
  • Master's Degree in nursing or health care related field: Preferred
  • Experience in case management, utilization management, and/or transitional care: Preferred

Licenses/Certifications:

  • Registered Nurse (RN) licensure in the state of practice: Required
  • Accredited Case Manager, Certified Case Manager, or Board Certification in Case Management: Preferred

Facility Specific License/Certifications:

  • Hospital Fire and Life Safety (HLFS): Required

Essential Functions:

  • Acts as a resource to ED staff and physicians regarding appropriateness of admission, levels of care (including related documentation requirements and observation vs. inpatient requirements), quality of care concerns and criteria/guidelines/protocols utilized in care planning and resource utilization.
  • Gathers sufficient information from and communicates with all relevant sources to facilitate appropriate discharge from ED to appropriate level of care to assure it is done in an accurate, safe, timely and cost-effective manner to prevent readmission and/or frequent visits to ED.
  • Assists in triaging calls from other acute care facilities requesting patient transfers to EMC; determines transfer appropriateness by reviewing requested documentation and InterQual level of care criteria and discussions as necessary with admitting physician, supervisors and/or EMC administrators and/or other EMC personnel.
  • Assesses ED patients and identifies options other than acute hospital admission when appropriate. Screens and refers to acute rehabilitation, long-term acute care hospitals, and nursing homes for admission directly from the ED; screens and refers patients to clinics after initial exam; and screens and refers patients for whom treatments could be safely rendered at home with services (e.g., IV antibiotics, low molecular weight heparin injections, wound care, etc.).
  • Organizes, integrates, and evaluates the effectiveness of the plan of care and progress toward achievement of desired outcomes. Modifies plan of care as patient/family needs change to accomplish goals established in the plan of care. Communicates plan of care, including changes and issues related to plan of care to patient/family, physicians, and other members of the healthcare team.
  • Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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