... Interqual guidelines. - Prefer demonstrated ability to learn SMHCS related facilities/services. - Prefer interpersonal communication skills and the ability to work effectively in a team. - Prefer ...
... Interqual guidelines. - Prefer demonstrated ability to learn SMHCS related facilities/services. - Prefer interpersonal communication skills and the ability to work effectively in a team. - Prefer ...
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources ...
New
Use available resources such as InterQual, MCG, the Pinson & Tang CDI Pocket Guide, encoding and grouping software, and AHA Coding Clinic guidance. * Follow client-directed priorities, escalation ...
Quick apply
Use available resources such as InterQual, MCG, the Pinson & Tang CDI Pocket Guide, encoding and grouping software, and AHA Coding Clinic guidance. * Follow client-directed priorities, escalation ...
Clinical Appeals Nurse
Cooper City, FL · On-site
Utilize clinical experience and knowledge in accordance with established Milliman or Interqual guidelines to substantiate medical necessity and appropriate level of care. * Collaborate with health ...
Clinical Appeals Nurse
Cooper City, FL · On-site
Utilize clinical experience and knowledge in accordance with established Milliman or Interqual guidelines to substantiate medical necessity and appropriate level of care. * Collaborate with health ...
Clinical Appeals Nurse
Cooper City, FL · On-site
Utilize clinical experience and knowledge in accordance with established Milliman or Interqual guidelines to substantiate medical necessity and appropriate level of care. * Collaborate with health ...
Clinical Appeals Nurse
Cooper City, FL · On-site
Utilize clinical experience and knowledge in accordance with established Milliman or Interqual guidelines to substantiate medical necessity and appropriate level of care. * Collaborate with health ...
Director of Case Management, Case Management Dept, Full Time, Day Shift, Job ID # 1827958
Hialeah, FL · On-site
McKesson InterQual ® experience preferred. Five years acute hospital case management experience preferred. Required skills include demonstrated organizational skills, excellent verbal and written ...
Director of Case Management, Case Management Dept, Full Time, Day Shift, Job ID # 1827958
Hialeah, FL · On-site
McKesson InterQual ® experience preferred. Five years acute hospital case management experience preferred. Required skills include demonstrated organizational skills, excellent verbal and written ...
Care Review Clinician
Miami, FL · On-site
Interqual or Millimen Utilization Management experience
Care Review Clinician
Miami, FL · On-site
Interqual or Millimen Utilization Management experience
Applies submitted information to KFHP authorization process (utilizing Milliman, USA, Interqual medical guidelines, Process Standards, Policies and Procedures, and Standard Operating Procedures)
Applies submitted information to KFHP authorization process (utilizing Milliman, USA, Interqual medical guidelines, Process Standards, Policies and Procedures, and Standard Operating Procedures)
Knowledge of reimbursement principles, discharge planning process, InterQual and/or Milliman criteria. * Advanced written, verbal and interpersonal skills. * Must be able to deal effectively with ...
Knowledge of reimbursement principles, discharge planning process, InterQual and/or Milliman criteria. * Advanced written, verbal and interpersonal skills. * Must be able to deal effectively with ...
Senior Registered Nurse
Miami, FL · On-site
Applies submitted information to KFHP authorization process (utilizing Milliman, USA, Interqual medical guidelines, Process Standards, Policies and Procedures, and Standard Operating Procedures)
Senior Registered Nurse
Miami, FL · On-site
Applies submitted information to KFHP authorization process (utilizing Milliman, USA, Interqual medical guidelines, Process Standards, Policies and Procedures, and Standard Operating Procedures)
Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals Nice to haves: Medicare Appeals Experience Disqualifiers: Not having a valid/active RN/LPN ...
New
Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals Nice to haves: Medicare Appeals Experience Disqualifiers: Not having a valid/active RN/LPN ...
New
In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer ...
In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer ...
Apply InterQual, MCG, or client-approved criteria to support medical necessity, level of care, continued stay, and patient-status determinations. * Obtain, submit, and track payer notifications and ...
New
Quick apply
Apply InterQual, MCG, or client-approved criteria to support medical necessity, level of care, continued stay, and patient-status determinations. * Obtain, submit, and track payer notifications and ...
New
Nurse Reviewer - Sarasota, FL
Sarasota, FL · Remote
$40/hr
Clinical criteria (InterQual and MCG) * Utilization/Medical record review and chart abstraction * Current standards of medical practice * Comply with HIPAA/HITECH laws and regulations Experience in:
Nurse Reviewer - Sarasota, FL
Sarasota, FL · Remote
$40/hr
Clinical criteria (InterQual and MCG) * Utilization/Medical record review and chart abstraction * Current standards of medical practice * Comply with HIPAA/HITECH laws and regulations Experience in:
Nurse Reviewer - Orlando, FL
Orlando, FL · Remote
$40/hr
Clinical criteria (InterQual and MCG) * Utilization/Medical record review and chart abstraction * Current standards of medical practice * Comply with HIPAA/HITECH laws and regulations Experience in:
Nurse Reviewer - Orlando, FL
Orlando, FL · Remote
$40/hr
Clinical criteria (InterQual and MCG) * Utilization/Medical record review and chart abstraction * Current standards of medical practice * Comply with HIPAA/HITECH laws and regulations Experience in:
Nurse Reviewer - Tampa, FL
Tampa, FL · Remote
$40/hr
Clinical criteria (InterQual and MCG) * Utilization/Medical record review and chart abstraction * Current standards of medical practice * Comply with HIPAA/HITECH laws and regulations Experience in:
Nurse Reviewer - Tampa, FL
Tampa, FL · Remote
$40/hr
Clinical criteria (InterQual and MCG) * Utilization/Medical record review and chart abstraction * Current standards of medical practice * Comply with HIPAA/HITECH laws and regulations Experience in:
Interqual information
See Florida salary details
$29.1K - $37.6K
15% of jobs
$37.6K - $46K
8% of jobs
$47.2K is the 25th percentile. Wages below this are outliers.
$46K - $54.4K
15% of jobs
The median wage is $59.7K / yr.
$54.4K - $62.8K
20% of jobs
$62.8K - $71.3K
11% of jobs
$75.5K is the 75th percentile. Wages above this are outliers.
$71.3K - $79.7K
13% of jobs
$79.7K - $88.1K
5% of jobs
$88.1K - $96.5K
3% of jobs
$96.5K - $105K
4% of jobs
$105K - $113.4K
3% of jobs
$113.4K - $121.8K
3% of jobs
$29.1K
$66.9K
$121.8K
How much do interqual jobs pay per year?
As of Aug 23, 2026, the average yearly pay for interqual in Florida is $66,870.00, according to ZipRecruiter salary data. Most workers in this role earn between $48,200.00 and $78,100.00 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 the most commonly searched types of Interqual jobs in Florida?
The most popular types of Interqual jobs in Florida are:
What are popular job titles related to Interqual jobs in Florida?
For Interqual jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Interqual jobs in Florida look for?
The top searched job categories for Interqual jobs in Florida are:
Full-time
Re-posted yesterday
Sarasota Memorial Health Care System rating
7.5
Based on 104 frontline employees who took The Breakroom Quiz
239th of 893 rated healthcare providers
Job description
Department
Medical Management Services
Job Summary
Required Qualifications
Preferred Qualifications
Employment Screening Requirements
As part of Sarasota Memorial Health Care System's commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/Qualifications:
Medical Management Services
Job Summary
Manages the health status of the member population under the direction of the plan Medical Director. The Clinical Care Facilitator will manage the medical care throughout the continuum of care.
Required Qualifications
- Require a minimum of three (3) years previous healthcare experience, preferably in population care management.
- Require an current/active State of Florida Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) licensure.
Preferred Qualifications
- Prefer previous indigent patient care management experience.
- Prefer Certified Case Manager (CCM) certification from the Commission for Case Manager.
- Prefer previous health plan, inpatient care and outpatient physician office experience.
- Prefer familiarity with Milliman USA and Interqual guidelines.
- Prefer demonstrated ability to learn SMHCS related facilities/services.
- Prefer interpersonal communication skills and the ability to work effectively in a team.
- Prefer demonstrated ability to work independently.
- Prefer demonstrated ability to interact with SMHCS Medical Staff.
- Prefer proficiency in WEB Platforms, Word, Excel, Windows and CareVision.
- Prefer a Bachelor's degree in related field.
Hours: Monday thru Friday, 8:30am - 4:00pm.
Employment Screening Requirements
As part of Sarasota Memorial Health Care System's commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/Qualifications:
- Prefer previous indigent patient care management experience.
- Prefer Certified Case Manager (CCM) certification from the Commission for Case Manager.
- Prefer previous health plan, inpatient care and outpatient physician office experience.
- Prefer familiarity with Milliman USA and Interqual guidelines.
- Prefer demonstrated ability to learn SMHCS related facilities/services.
- Prefer interpersonal communication skills and the ability to work effectively in a team.
- Prefer demonstrated ability to work independently.
- Prefer demonstrated ability to interact with SMHCS Medical Staff.
- Prefer proficiency in WEB Platforms, Word, Excel, Windows and CareVision.
- Prefer a Bachelor's degree in related field.
What Sarasota Memorial Health Care System employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Sarasota Memorial Health Care System
Sourced by ZipRecruiter
Sarasota Memorial Health Care System, based in Sarasota, FL, US, is a community-owned and operated healthcare provider entrenched in the medical and health services industry. Known for offering a wide array of comprehensive care, their extensive services range from disease prevention and detection to advanced treatment and rehabilitation. The company, established in 1925, began as a 14-bed hospital and has evolved into an 839-bed regional medical center, becoming one of the region's largest public health systems. Sarasota Memorial's mission is to deliver healthcare service of the highest quality in keeping with their core values, including community, excellence, loyalty, innovation, respect, and teamwork.
Industry
Health care and social assistance
Company size
5,001 - 10,000 Employees
Headquarters location
Sarasota, FL, US
Year founded
1925