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Interqual Jobs in Arizona (NOW HIRING)

Kingman Regional Medical Center

Physician

Kingman, AZ · On-site

Familiarity with standard published leveling criteria such as MCG/InterQual and ability to apply professional judgment and patient-specific variables as may be necessary or justifiable Preferences ...

Endeavor Health

$40.45 - $62.70/hr

Knowledge of InterQual or MCG criteria is preferred. What you will do: * Facilitates payor authorization processes and ensures that the patient type assigned is accurate. * Facilitates the ...

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Showing results 21-40

All JobsInterqual JobsInterqual Jobs in Arizona

Interqual information

See Arizona salary details

$36.3K

$83.4K

$151.9K

How much do interqual jobs pay per year?

As of Aug 7, 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 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 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 are the most commonly searched types of Interqual jobs in Arizona? The most popular types of Interqual jobs in Arizona are:
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 4% As Needed, 68% Full Time, 13% Part Time, and 15% Contract. Highlights an 88% In-person, 2% Hybrid, and 10% Remote job distribution, with an average salary of $83,388 per year, or $40.1 per hour.

Prior Authorization RN Reviewer

Medasource

Phoenix, AZ • On-site

Other

Re-posted 17 hours ago

Job description

POSITION SUMMARY: The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with the health plan’s policies. This RN plays a critical role in supporting cost-effective care while ensuring quality and compliance in alignment with regulatory and accreditation standards.


CORE FUNCTIONS

1. Manages health Plan consumer/beneficiaries across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes.


2. Provides pre-service determinations, concurrent review, and case management functions within Medical Management. Ensures quality of service and consistent documentation.


3. Works collaboratively with both internal and external customers in assisting health Plan consumers/beneficiaries and providers with issues related to prior authorization, utilization management, and/or case management. Meets internal and external customer service expectations regarding duties and professionalism.


4. Performs transfer of accurate, pertinent patient information to support the pre-service determination(s), the transition of patient care needs through the continuum of care, and performs follow-up calls for advanced care coordination. Documents accurately and timely, all interventions and necessary patient-related activities in the correct medical record.


5. Evaluates the medical necessity and appropriateness of care, optimizing health Plan consumer/beneficiary outcomes. Identifies issues that may delay patient services and refers to case management, when indicated, to facilitate resolution of these issues, pre-service, concurrently, and post-service.


6. Provides ongoing education to internal and external stakeholders who play a critical role in the continuum of care model. Training topics consist of population health management, evidence-based practices, and all other topics that impact medical management functions.


7. Identifies and refers requests for services to the appropriate Medical Director and/or other physician clinical peer when guidelines are not clearly met. Conducts call rotation for the health plan, as well as departmental call rotation for holidays.


8. Maintains a thorough understanding of each plan, including the Evidence of Coverage, Summary Plan Description, authorization requirements, and all applicable federal, state, and commercial criteria, such as CMS, MCG, and Hayes.


Minimum Qualifications:

  • Active RN license -- AZ License or Compact State License
  • Experience working in inpatient & outpatient settings
  • Focus on Outpatient Prior Auths for surgeries and DME (Durable Medical Equipment)
  • Medicare review experience is highly preferred
  • Experience with reviewing guidelines (this position is more pre-service)
  • Experience with MCG criteria, CareWebQI & Interqual
  • Utilization Management experience required
  • Payer background major plus


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