... 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 ...
Review medical necessity using InterQual criteria. * Facilitate utilization review and resource management. * Coordinate post-acute care services and community resources. * Document patient care ...
Review medical necessity using InterQual criteria. * Facilitate utilization review and resource management. * Coordinate post-acute care services and community resources. * Document patient care ...
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 ...
Quick apply
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 ...
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 ...
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 ...
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 ...
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)
Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care ...
Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care ...
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:
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 - 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:
Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care ...
Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care ...
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 ...
Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care ...
Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care ...
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 ...
... 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 ...
Clinical Care Reviewer
Doral, FL · On-site
ER, ICU) Experience with Utilization Review and/or Prior Authorization Familiar with Interqual Criterion Knowledge of MS Office including Word, Excel, and Outlook Responsible for completing medical ...
Clinical Care Reviewer
Doral, FL · On-site
ER, ICU) Experience with Utilization Review and/or Prior Authorization Familiar with Interqual Criterion Knowledge of MS Office including Word, Excel, and Outlook Responsible for completing medical ...
Make medical necessity determinations using MCG/InterQual/CMS criteria * Conduct peer-to-peer reviews and support UM staff * Participate in committees and provider education as needed Requirements
Quick apply
Make medical necessity determinations using MCG/InterQual/CMS criteria * Conduct peer-to-peer reviews and support UM staff * Participate in committees and provider education as needed Requirements
Physician Assistant PPR, Pediatric Transplant, Holtz Women and Children's Hospital, Per Diem, Days
Miami, FL · On-site
Identifies patients to be case managed using MediFax, DDE or other system applying InterQual, M&R, First Health or other specific criteria related to diagnosis, clinical condition, cost and/or payor.
Physician Assistant PPR, Pediatric Transplant, Holtz Women and Children's Hospital, Per Diem, Days
Miami, FL · On-site
Identifies patients to be case managed using MediFax, DDE or other system applying InterQual, M&R, First Health or other specific criteria related to diagnosis, clinical condition, cost and/or payor.
Supervisor Care Coordination, Case Management, FT, 8:30A-5P
Homestead, FL · On-site
$92K - $123K/yr
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 ...
Supervisor Care Coordination, Case Management, FT, 8:30A-5P
Homestead, FL · On-site
$92K - $123K/yr
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 ...
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 1, 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 are the typical daily responsibilities of someone working with InterQual criteria in a healthcare setting?
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, and why are they important?
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 job?
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 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:
- Flexible Cvs Utilization Management Nurse
- Part Time Utilization Review Nurse
- Physician Case Reviewer
- Remote Telephonic Nurse
- No Experience Utilization Management Nurse
- Remote Cvs Utilization Management Nurse
- Weekend Physician Advisor Utilization Review
- Non Exempt No Experience Utilization Management Nurse
- Night Utilization Review Nurse
- Full Time Physician Advisor Utilization Review
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 10 days ago
Sarasota Memorial Health Care System rating
7.4
Based on 103 frontline employees who took The Breakroom Quiz
262nd of 887 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