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Interqual Training Operation Jobs (NOW HIRING)

Guidehouse

Supervisor Clinical Appeals/UM

$77K - $129K/yr

This role provides operational leadership, clinical guidance, quality oversight, and performance ... team meetings, training sessions, and ongoing education initiatives. • Manage staffing ...

Dane Street, LLC

Clinical Group Health Trainer

Strong background in clinical operations, training, or quality assurance. * Extensive experience in ... InterQual. * Proficient in rationale writing and translation to patient-friendly language.

Medix

Clinical Reviewer

Phoenix, AZ · On-site

$40 - $42/hr

Has training and experience in utilization of ASAM Criteria (3rd Ed.). Experience * Experience with ... InterQual experience. Skills * Experience with Microsoft software such as Outlook, Teams, and ...

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Interqual Training Operation information

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How much do interqual training operation jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for interqual training operation in the United States is $19.89, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $25.00 per hour, depending on experience, location, and employer.

What are the main challenges faced by professionals working in Interqual Training Operations, and how can they be addressed?

Professionals in Interqual Training Operations often encounter challenges such as staying current with evolving clinical guidelines and ensuring consistent training across diverse healthcare teams. Addressing these challenges involves regularly updating training materials, fostering strong communication with clinical staff, and leveraging feedback to improve training sessions. Collaboration with both clinical experts and IT teams is crucial to ensure that Interqual criteria are implemented effectively and understood organization-wide. Continuous professional development and adaptability are key to success in this dynamic environment.

What is the difference between Interqual Training Operation vs Interqual Clinical Reviewer?

AspectInterqual Training OperationInterqual Clinical Reviewer
CredentialsTypically requires training certifications in utilization management and Interqual softwareRequires clinical licenses (RN, MD, or other healthcare credentials) and familiarity with Interqual criteria
Work EnvironmentTraining sessions, administrative settings, healthcare organizationsClinical settings, hospitals, insurance companies, utilization review departments
Employer & Industry UsageHealthcare organizations, training providers, health plansInsurance companies, healthcare providers, utilization review agencies

Interqual Training Operations focus on delivering training and managing Interqual software, while Interqual Clinical Reviewers evaluate patient cases using Interqual criteria to determine care appropriateness. Both roles require familiarity with Interqual but differ in responsibilities and credentials.

What is Interqual Training Operation?

Interqual Training Operation refers to the processes and programs designed to educate healthcare professionals on using InterQual criteria, which are evidence-based clinical decision support tools. These trainings help users understand how to apply InterQual guidelines for patient admissions, continued stays, and discharge decisions. Effective Interqual Training Operation ensures staff are proficient in utilizing the software and criteria to promote appropriate care and compliance with regulations. The training may include online modules, in-person sessions, and ongoing support to address updates and best practices.

What are the key skills and qualifications needed to thrive in Interqual Training Operations, and why are they important?

To excel in Interqual Training Operations, you need a strong understanding of clinical guidelines, healthcare utilization management, and experience with InterQual criteria, typically supported by a background in nursing or healthcare administration. Familiarity with InterQual software, learning management systems (LMS), and relevant certifications such as RN or case management credentials is crucial. Excellent communication, instructional skills, and attention to detail help trainers effectively educate teams and ensure compliance. These skills are vital for ensuring accurate application of clinical guidelines, improving patient outcomes, and maintaining regulatory standards.
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What cities are hiring for Interqual Training Operation jobs? Cities with the most Interqual Training Operation job openings:
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Interqual Training Operation jobs near you
Infographic showing various Interqual Training Operation job openings in the United States as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $41,374 per year, or $19.9 per hour.
Case Manager-Case Management-HHK

Case Manager-Case Management-HHK

Gila River Health Care Corp

Sacaton, AZ • On-site

Full-time

Re-posted yesterday

Gila River Health Care rating

8.0

Company rating: 8.0 out of 10

Based on 23 frontline employees who took The Breakroom Quiz

Job description

Summary:
The Case Manager will provide comprehensive Case Management for patients as assigned to include, but not limited to: assessing patient's needs; developing, implementing, monitoring, and documenting the progress of the patient throughout their hospitalization in an outside area hospital to meet their care needs prior to discharge. The intensity of Case Management is situational and appropriately based on patient need. This position is accountable for the quality of clinical services provided by both them and others and identifies barriers which may hinder effective patient care. The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing patient admissions and continued stay criteria to identify issues that may delay patient discharge and facilitate resolution of these issues.
Critical Tasks:
  • Demonstrates a culture of kindness through all interactions whether verbal or non-verbal with all GRHC staff members, partner facilities staff and vendors.
  • Manages and oversees assigned patient case load to ensure delivery of all covered services identified for continuity of care across all levels of care and involved providers to achieve the optimal clinical, financial, operational, and patient satisfaction outcomes.
  • Maintains HIPAA standards of patient confidentiality during all interactions whether written, verbal, or electronic.
  • Establishes and promotes a collaborative relationship with members of the healthcare team within GRHC and outside facility partners.
  • Serves as Case Manager between referral hospitals, treatment facilities and patients/patient's families to ensure delivery of effective and appropriate assistance and follow-up for returning to pre/post hospitalization status/care.
  • Reviews charts of assigned patients to determine appropriate referral services based on assessed patient needs.
  • Facilitates, schedules and/or participates in a variety of patient Case Management activities to ensure patient and/or family personal and health care needs are met in a timely manner; proactively identifies alternative resources as needed.
  • Participates in "on-call" for Case Management Department and Utilization Review
  • Performs Utilization Review of patient chart to ensure compliance with established InterQual criteria to maximize reimbursement/coverage of charges.
  • Evaluates inpatient medical necessity and appropriateness of care utilizing InterQual criteria, for optimizing outcomes.
  • Assesses patient admissions and continued stay to identify issues that may delay patient discharge and communicates to the interdisciplinary team while facilitating a resolution.
  • Collects and communicates pertinent, timely information to the health care team to fulfill utilization and regulatory requirements.
  • Collaborates with patient, family members, and other involved parties to ensure care coverage through private and governmental health care plans.
  • Collects outcome data to be used in identifying best practices and targeting performance improvement solutions.
  • Participates in departmental orientation, on the job training, and quality assurance programs/initiatives.
  • Receives and responds to patient concerns; research issues for corrective action as appropriate based on findings; escalates physician/provider concerns to appropriate parties and identifies alternative solutions.
  • Participates in a variety of department and hospital educational programs to maintain current skill and competency levels; identifies and discusses performance or training needs with Supervisor.
  • Participates in Community Events representing GRHC and Case Management Department with ability to educate on departmental functions.
  • Other duties as assigned by Case Management Director/Manager
  • Establishes goals and objectives for the department that meet or exceed GRHC's Code of Ethics and Standards for Conduct Policy.
  • Is familiar and remains current on safety and emergency management process for the department.

Required Qualifications:
  • Current State of Arizona or Compact State Registered Nurse license, BSN preferred.
  • Current CPR for Healthcare professional's certification
  • Must have at least 1-year previous case management experience, CCM certification preferred but must obtain within 2 years of hire.
  • Experience must include working in an acute care and/or home care setting for at least a 12-month period.
  • Native American population preferred.
  • Must have a working knowledge of Case Management, acute care and/or home care environments, community resources and resource/utilization management.
  • Case Management Specialty Area Requirements:
    • Pediatrics Case Manager - Must have at least 1 year Pediatrics experience
    • Cancer Case Manager - Must have at least 1 year oncology/hospice/or cancer case management experience
    • Pain Management Case Manager - Must have at least 1 year experience working with pain management patients/hospice patients.
    • Women's Health/High Risk Pregnancy Case Manager - Must have at least 1 year Women's Health/Pregnancy experience
    • Family Medicine Case Manager - Must have at least 1 year Medical-Surgical or Family Clinic experience
    • Internal Medicine Case Manager - Must have at least 1 year Medical-Surgical or Family Clinic experience
    • Emergency Department/Utilization Review Case Manager - Must have 1 year Medical-Surgical experience and/or 1 year Utilization Review experience

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