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Interqual Jobs in Georgia (NOW HIRING)

Bestica Healthcare

RN Case Manager

Atlanta, GA · On-site

Utilize InterQual Criteria * Utilize Milliman Guidelines Utilization Review: * Admission Criteria Appeals and Denials * Concurrent Review * Continued Stay Reviews * Medical Necessity * Retrospective ...

Piedmont Healthcare Inc.

Care Manager

Atlanta, GA · On-site

Experience using InterQual or Milliman Preferred Licenses and Certifications * RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required * Certification in Case or ...

Piedmont Healthcare Inc.

Care Manager

Atlanta, GA

Experience using InterQual or Milliman Preferred Licenses and Certifications * RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required * Certification in Case or ...

Piedmont Healthcare Inc.

Care Manager

Atlanta, GA

Experience using InterQual or Milliman Preferred Licenses and Certifications * RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required * Certification in Case or ...

Piedmont Healthcare Inc.

Care Manager

Atlanta, GA · On-site

Experience using InterQual or Milliman Preferred Licenses and Certifications * Current unrestricted registered nurse (RN) license, or eligible for licensure, in the state of Georgia Required ...

Piedmont Healthcare Inc.

Care Manager

Atlanta, GA · On-site

Experience using InterQual or Milliman Preferred Licenses and Certifications * Current unrestricted registered nurse (RN) license, or eligible for licensure, in the state of Georgia Required ...

Piedmont Healthcare Inc.

Care Manager

Atlanta, GA · On-site

Experience using InterQual or Milliman Preferred Licenses and Certifications * Current unrestricted registered nurse (RN) license, or eligible for licensure, in the state of Georgia Required ...

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Interqual information

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 Georgia? The most popular types of Interqual jobs in Georgia are:
What are popular job titles related to Interqual jobs in Georgia? For Interqual jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Interqual jobs in Georgia look for? The top searched job categories for Interqual jobs in Georgia are:
Interqual jobs near you
Infographic showing various Interqual job openings in Georgia as of August 2026, with employment types broken down into 5% As Needed, 66% Full Time, 12% Part Time, and 17% Contract. Highlights an 86% In-person, 2% Hybrid, and 12% Remote job distribution.

RN Case Manager

Bestica Healthcare

Atlanta, GA • On-site

Other

Re-posted 16 days ago

Job description

Job Title

Experience: 3 years Required, Any Preferred Preferred Preferred Yes

Certs marked with * are preferred BLS Skills marked with * are preferred

Work Settings:

  • Acute Hospital
  • Long Term Acute Care/Rehab/Skilled Nursing

Case Management/Utilization Review:

  • Admission Criteria
  • Care coordination
  • Discharge Planning
  • Utilize InterQual Criteria
  • Utilize Milliman Guidelines

Utilization Review:

  • Admission Criteria Appeals and Denials
  • Concurrent Review
  • Continued Stay Reviews
  • Medical Necessity
  • Retrospective Review
  • Utilize InterQual Criteria
  • Utilize Milliman Guidelines

Regulatory:

  • CMS: Centers for Medicare and Medicaid Services
  • CPT (Current Procedural Terminology) coding and billing
  • Department of Health
  • DRG (Diagnosis Related Groups)
  • HEDIS (The Healthcare Effectiveness Data and Information Set) Measures
  • HIPAA guidelines (Health Insurance Portability and Accountability Act)
  • ICD 10 Coding
  • NCQA (National Committee for Quality Assurance)
  • OSHA
  • The Joint Commission/Core Measure/National Safety Goals
  • Workers Compensation

Unit Details:

  • Block
  • Days: - Nights: - Weekends: -
  • Yes Note: Within facility/scope of practice as needed

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