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Interqual Training Operation Jobs (NOW HIRING)

Mercor

Utilisation Management Expert - RN

New York, NY · Remote

$100 - $150/hr

Lead utilisation management and case management operations, including concurrent review ... Conduct and oversee clinical reviews against InterQual , MCG , or Milliman care guidelines to ...

Sentara Health

Anesthesiology Physician

Suffolk, VA · On-site

$380K/yr

Complete required training and continuing education. * Support additional responsibilities as ... Regulations, InterQual, MCG, DRG, Hospital Operations, Medical Staff Engagement, Healthcare ...

YES HIM Consulting, Inc

Clinical Appeals Specialist

Sage Clinical RCM provides operational oversight, while designated client staff direct daily ... Use available resources such as InterQual, MCG, the Pinson & Tang CDI Pocket Guide, encoding 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 Aug 22, 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 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?

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.

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.

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Cities with the most Interqual Training Operation job openings:

What states have the most Interqual Training Operation jobs?

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Interqual Training Operation jobs near you
Infographic showing various Interqual Training Operation job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 16% Part Time, and 1% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $41,374 per year, or $19.9 per hour.

Prior Authorisation Manager - Clinical Expert

Mercor

New York, NY • Remote

$150/hr

Full-time

Re-posted 22 days ago

Job description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Prior Authorisation Manager
Type: Contract
Compensation: $150/hour
Location: Remote

Role Responsibilities

  • Manage end-to-end prior authorisation workflows for medical and clinical services across multiple payer types.
  • Review clinical documentation to assess medical necessity against InterQual, MCG, or payer-specific criteria.
  • Evaluate AI-generated prior authorisation recommendations and clinical justification drafts for accuracy and appropriateness.
  • Coordinate with clinical staff, physicians, and payers to obtain timely authorisation approvals.
  • Track authorisation status, denials, and appeal outcomes to identify workflow improvement opportunities.
  • Annotate AI outputs and provide structured clinical feedback to support AI training datasets.

Qualifications

Must-Have

  • 5+ years of experience in prior authorisation, utilisation management, or clinical review, with at least 2 years in a management role.
  • Strong clinical background with knowledge of medical necessity criteria (InterQual, MCG, or equivalent).
  • Deep familiarity with commercial, Medicare Advantage, and Medicaid prior authorisation requirements.
  • Experience managing authorisation workflows across multiple specialities and service types.
  • Proficiency with authorisation management systems and EHR platforms (Epic, Cerner, or equivalent).
  • Exceptional written and verbal English communication skills.
  • High attention to detail with the ability to critically evaluate clinical documentation and AI-generated outputs.

Preferred

  • Clinical licensure (RN, LPN, or equivalent) or relevant certification (CPUR, CPUM).
  • Experience with appeals and peer-to-peer review processes.
  • Familiarity with CMS prior authorisation rules and the No Surprises Act.
  • Background in physician office, hospital, or health plan prior authorisation operations.
  • Familiarity with AI tools and comfort evaluating AI-generated clinical content.

Application Process (Takes 20–30 mins to complete)

  • Upload resume
  • AI interview based on your resume
  • Submit form

Resources & Support

  • For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
  • For any help or support, reach out to: support@mercor.com

PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.