1

Hourly Interqual Jobs in Minnesota (NOW HIRING)

SSBV Clinical Claim Review RN

Plymouth, MN · On-site

$28.94 - $51.83/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters ... The hourly pay for this role will range from $28.94 to $51.83 per hour based on full-time ...

SSBV Clinical Claim Review RN

Plymouth, MN · Remote

$28.94 - $51.83/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Familiarity with InterQual and/or MCG Care Guidelines * Critical thinking skills *All Telecommuters ... The hourly pay for this role will range from $28.94 to $51.83 per hour based on full-time ...

Hourly Interqual information

What is an hourly InterQual job?

Hourly Interqual jobs typically involve reviewing and applying InterQual criteria, which are evidence-based clinical guidelines, to determine the appropriate level of care for patients in a healthcare setting. Professionals in these roles, such as nurses or case managers, assess clinical documentation and patient needs on an hourly or shift basis to ensure medical necessity and compliance with regulations. These positions are important in hospitals and insurance companies to support authorization decisions, utilization management, and quality assurance. Hourly Interqual jobs may require experience with clinical review tools, strong critical thinking skills, and a background in nursing or related healthcare fields.

What skills and qualifications are needed to thrive as an InterQual Utilization Review Specialist?

To thrive as an InterQual Utilization Review Specialist, you need a background in nursing or healthcare, strong analytical skills, and knowledge of clinical guidelines, often supported by an RN license or related qualification. Proficiency with InterQual software, electronic medical records (EMRs), and utilization management systems is essential. Attention to detail, critical thinking, and effective communication are important soft skills for evaluating cases and collaborating with care teams. These competencies ensure accurate patient assessments, compliance with regulations, and optimal resource utilization in healthcare settings.

What are common challenges faced by hourly InterQual reviewers when assessing patient cases, and how can they be managed?

Hourly Interqual reviewers often encounter challenges such as interpreting complex clinical data, navigating ambiguous documentation, and ensuring timely reviews to support patient care decisions. Effective communication with clinical staff and ongoing education on Interqual criteria can help address these challenges. Collaborating closely with case managers and physicians also ensures accurate assessments and supports efficient patient throughput.

What is the difference between Hourly Interqual vs Hourly Case Manager?

AspectHourly InterqualHourly Case Manager
CredentialsTypically requires nursing or healthcare certifications, such as RN or LPNRequires nursing, social work, or healthcare-related certifications, such as RN, LCSW, or case management certification
Work EnvironmentHospitals, insurance companies, or healthcare facilities focusing on utilization reviewHospitals, clinics, insurance companies, or community health settings
Employer & Industry UsageUsed mainly for clinical decision support and utilization managementUsed for coordinating patient care, discharge planning, and resource management

Hourly Interqual focuses on clinical criteria for utilization review, while Hourly Case Manager emphasizes patient care coordination and discharge planning. Both roles require healthcare certifications and work in similar environments, but their primary functions differ in clinical decision support versus patient management.

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

The most popular types of Interqual jobs in Minnesota are:

SSBV Clinical Claim Review RN

UnitedHealth Group

Plymouth, MN • On-site

$28.94 - $51.83/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago


UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

189th of 887 rated healthcare providers


Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.
Let's face it, no industry is moving faster than health care. And no organization is better positioned to lead health care forward than UnitedHealthcare, part of the UnitedHealth Group family of businesses. As a SSBV Clinical Claims Review RN, you can put your skills and talents to work. This is a multifaceted role that is highly rewarding.
It feels great to have autonomy, though there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact on our members. And at the same time, you'll be challenged by a demanding case load in a rapidly changing, production-driven environment.
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Perform administrative reviews of short stay inpatient hospital claims in accordance with Federal, State and client specific requirements
  • Responsible for documentation of all determinations
  • Maintain accurate use of screening criteria

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Associate's degree
  • Current and unrestricted RN license in the state of residency
  • 5+ years of clinical documentation experience
  • 3+ years of experience as an RN, including inpatient/acute setting
  • Intermediate level of proficiency in Microsoft Office (to include Microsoft Excel and One Note)
  • Intermediate level of proficiency in writing
  • Designated home office workspace with access to install secure high-speed internet via cable/DSL

Preferred Qualifications:
  • Undergraduate or higher degree
  • A background in utilization review for an insurance company or experience in case management
  • Familiarity with InterQual and/or MCG Care Guidelines
  • Critical thinking skills

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN

What UnitedHealth Group employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom