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Interqual Jobs in Arizona (NOW HIRING)

Actalent

Clinical Concurrent Review Nurse

Phoenix, AZ · On-site

Familiarity with InterQual, MCG, or other medical necessity guidelines preferred. * Knowledge of utilization management processes preferred. * Ability to interpret and apply clinical criteria to ...

Medix

Clinical Reviewer

Phoenix, AZ · On-site

$150/hr

Utilize The ASAM Navigator by InterQual for determinations. * Document brief case summaries in Microsoft SharePoint. Qualifications * MD only with an active, unrestricted medical license (DO not ...

HOPCO

RN Case Manager - Utilization Review

Phoenix, AZ · On-site

Assess admission criteria and length of stay, applying standardized clinical guidelines such as InterQual or MCG to justify care levels. * Issue pre-authorizations for procedures, medications, and ...

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Interqual information

See Arizona salary details

$36.3K

$83.4K

$151.9K

How much do interqual jobs pay per year?

As of Sep 4, 2026, the average yearly pay for interqual in Arizona is $83,388.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,100.00 and $97,400.00 per year, depending on experience, location, and employer.

What is an InterQual?

An InterQual job typically involves using InterQual criteria—a set of evidence-based guidelines—to assess medical necessity for healthcare services. Professionals in these roles, such as nurses or case managers, review patient cases to ensure treatments align with best practices and insurance requirements. They work in hospitals, insurance companies, or healthcare organizations to support utilization management and improve patient care efficiency. Strong clinical knowledge and familiarity with InterQual software are often required for these positions.

What does someone working with InterQual do?

Professionals utilizing InterQual criteria are primarily responsible for reviewing medical records and assessing whether inpatient admissions, procedures, or continued stays meet established clinical guidelines. Daily tasks often include documenting findings, communicating with physicians and care teams to clarify case details, and collaborating with insurance companies regarding authorization of services. These professionals act as a key resource for ensuring compliance with industry standards and optimizing patient care pathways. Successful InterQual specialists proactively identify discrepancies and help resolve issues that might delay care or reimbursement. You can expect regular interaction with both clinical and administrative staff in a fast-paced healthcare environment.

What are the key skills and qualifications needed to thrive in the InterQual position?

To excel in a role focused on InterQual, such as an InterQual Specialist or Utilization Review Nurse, you need a strong background in healthcare, clinical assessment skills, and familiarity with utilization management. Proficiency in using InterQual software, electronic health records (EHRs), and knowledge of medical necessity criteria are essential, and certification in case management or utilization review is often preferred. Attention to detail, strong analytical thinking, and effective communication are critical soft skills for this position. These skills ensure accurate case evaluations, appropriate care decisions, and efficient collaboration with healthcare providers and payer organizations.

What are popular job titles related to Interqual jobs in Arizona?

For Interqual jobs in Arizona, the most frequently searched job titles are:

What job categories do people searching Interqual jobs in Arizona look for?

The top searched job categories for Interqual jobs in Arizona are:

Interqual jobs near you
Infographic showing various Interqual job openings in Arizona as of August 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $83,388 per year, or $40.1 per hour.

Case Manager-Case Management-HHK

Gila River Health Care Corp

Sacaton, AZ • On-site

Full-time

Re-posted 21 days ago

Key responsibilities

  • Assess patients' needs and develop, implement, monitor, and document their care plans throughout hospitalization and post-discharge.

  • Perform Utilization Review to evaluate the medical necessity and appropriateness of care using InterQual criteria and identify issues delaying patient discharge.

  • Coordinate with healthcare team, patients, and families to ensure delivery of appropriate services, facilitate communication, and support effective patient care and discharge planning.

Gila River Health Care rating

8.2

Company rating: 8.2 out of 10

Based on 24 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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