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Interqual Case Management Jobs (NOW HIRING)

Tenet Health

Manager - Case Management

San Ramon, CA · On-site

$62.20 - $99.52/hr

... InterQual criteria • Ensures new case management staff complete department orientation including review of Tenet Case Management and Compliance policies and Allscripts training • Provides ...

Veracity

Director Case Management

Detroit, MI · On-site

Onsite The Director Case Management is responsible for overseeing utilization management ... InterQual Reviews * Physician Education * Acute Care Operations * Team Leadership & Staff ...

Veracity

Director Case Management

Detroit, MI · On-site

Onsite The Director Case Management is responsible for overseeing utilization management ... InterQual Reviews * Physician Education * Acute Care Operations * Team Leadership & Staff ...

TH Medical

Director - Case Management

Detroit, MI · On-site

McKesson InterQual experience preferred. Business planning experience preferred. 4. Accredited Case Manager (ACM) preferred. Skills Required 1. Analytical ability to serve in an advisory/consultative ...

TH Medical

Director - Case Management

Detroit, MI · On-site

McKesson InterQual experience preferred. Business planning experience preferred. 4. Accredited Case Manager (ACM) preferred. Skills Required 1. Analytical ability to serve in an advisory/consultative ...

Centstone HC

Social Worker & Case Management

Savannah, GA · On-site

$20.25 - $26.50/hr

... InterQual experience preferred · Currently licensed as a Registered Nurse in the state(s) of ... Case Management required for the entire hospital (612 bed academic medical center with a ...

Bestica Healthcare

RN case management

Corpus Christi, TX · On-site

Familiar with most of the following MIDAS, Meditech, Care Port Discharge, Outlook, Excel, Interqual ... HCA Case Management experience * NATE familiarity * HCA MDRs List typical procedures performed on ...

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Interqual Case Management information

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$19

$47

$80

How much do interqual case management jobs pay per hour?

As of Jun 5, 2026, the average hourly pay for interqual case management in the United States is $47.53, according to ZipRecruiter salary data. Most workers in this role earn between $35.34 and $57.45 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an InterQual Case Manager, and why are they important?

To thrive as an InterQual Case Manager, you need a solid background in nursing or healthcare, knowledge of utilization review, and familiarity with case management principles, often supported by RN licensure or similar clinical credentials. Expertise in using InterQual criteria software, electronic health records (EHRs), and utilization management systems is essential. Strong analytical thinking, communication, and collaboration skills help in effectively coordinating patient care and liaising with providers and payers. These skills ensure accurate patient evaluations, compliance with guidelines, and optimal resource utilization within healthcare settings.

What is InterQual Case Management?

InterQual Case Management refers to the use of InterQual criteria, which are evidence-based clinical guidelines, to assess the medical necessity, appropriateness, and level of care for patients within a healthcare setting. Case managers use these tools to ensure patients receive the right care at the right time while meeting insurance and regulatory requirements. This process helps in making decisions about hospital admissions, continued stays, and transitions of care. The goal is to improve patient outcomes and optimize resource utilization.

How does an Interqual Case Manager typically collaborate with healthcare teams to ensure effective patient care transitions?

Interqual Case Managers work closely with physicians, nurses, social workers, and other healthcare professionals to assess patient needs and determine appropriate levels of care using Interqual criteria. Their role often involves facilitating communication between different departments, coordinating discharge planning, and advocating for patient needs. By ensuring that each patient transition meets clinical guidelines, they help reduce readmission rates and support optimal health outcomes. Regular interdisciplinary meetings and thorough documentation are key aspects of their collaborative process.

What is the difference between Interqual Case Management vs Utilization Review Nurse?

AspectInterqual Case ManagementUtilization Review Nurse
CredentialsTypically requires nursing license, case management certificationRegistered Nurse (RN) license, often with utilization review certification
Work EnvironmentHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare facilities
Primary FocusCoordinating patient care, discharge planning, case managementReviewing medical necessity, approving or denying services
Usage in IndustryUsed for comprehensive case management and care coordinationPrimarily involved in utilization review and authorization processes

Both roles involve nursing expertise and work within healthcare settings, but Interqual Case Management focuses on coordinating patient care and discharge planning, while Utilization Review Nurses primarily evaluate medical necessity for services. Understanding these differences helps healthcare organizations assign the right professionals for each function.

Infographic showing various Interqual Case Management job openings in the United States as of May 2026, with employment types broken down into 1% As Needed, 35% Full Time, 60% Part Time, 2% Temporary, 1% Contract, and 1% Nights. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $98,869 per year, or $47.5 per hour.

Manager Case Management

Amaya Staffing Consultants LLC

Anaheim, CA • On-site

$140K - $214K/yr

Full-time

Posted 2 days ago

Job description


Job Title: Manager Case Management

Location: On-site, near Anaheim, CA

Salary Range: $140,000 - $214,000 + Relocation Assistance

Schedule: Full-Time – Admin Hours – Rotating Weekends


Company Information:


Our client is a respected hospital committed to delivering exceptional, patient-centered care in the community. They are currently seeking a full-time, permanent Manager for Case Management to join their dynamic team. This is a fantastic opportunity for a seasoned professional to lead and shape the case management department while contributing to the hospital’s overall success.


Job Summary:


We are looking for an experienced and motivated Manager Case Management to oversee and coordinate case management operations at an acute care facility. This role requires strong leadership skills and comprehensive knowledge of case management protocols and healthcare reimbursement systems.


Key Responsibilities:


  • Provide leadership and direction to the case management department.
  • Ensure compliance with federal and non-federal program rules and regulations regarding case management.
  • Develop and implement department policies and procedures to enhance patient care and efficiency.
  • Oversee staff training and development, fostering a collaborative and high-performing team.
  • Review and analyze case management practices, ensuring alignment with hospital goals and industry standards.
  • Maintain working knowledge of InterQual and Milliman & Robertson criteria.
  • Collaborate with interdisciplinary teams to address patient needs effectively.
  • Manage hospital reimbursement strategies across payers, including Medicare, Medi-Cal, Managed Care, and private insurance plans.


What Qualifications You Will Need:


  • Bachelor’s Degree in Nursing (BSN) required; Master’s Degree (MSN) preferred.
  • Current California Licensed Registered Nurse (RN) certification.
  • Minimum of 5 years of case management experience in an acute care hospital setting or nursing management experience in such environments.
  • In-depth knowledge of case management principles as defined by federal and non-federal programs.
  • Proficiency in using InterQual and M&R guidelines.
  • Solid understanding of hospital reimbursement mechanisms for various payer types.


Apply here today and send your resume to alex@amayastaffing.com