RN - Case Management
Augusta, 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 ...
RN - Case Management
Augusta, 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 ...
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 ...
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 ...
RN - Care Management, WEO
Snellville, 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 ...
RN - Care Management, WEO
Snellville, 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 ...
Care Manager, WEO, PRN
Newnan, 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 ...
Care Manager, WEO, PRN
Newnan, 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 ...
Care Manager, WEO, PRN
Newnan, 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 ...
Care Manager, WEO, PRN
Newnan, 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 ...
RN - Care Manager
Jasper, 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 ...
New
RN - Care Manager
Jasper, 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 ...
New
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 ...
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 ...
RN - Care Manager
Fayetteville, 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 ...
RN - Care Manager
Fayetteville, 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 ...
Review Nurse-PA/UM
Atlanta, GA · On-site
Refer cases that do not meet criteria and cannot be approved by InterQual criteria or nursing judgment to a Referral Nurse Coordinator who in turn assures review by a Peer Review Consultant on any ...
Review Nurse-PA/UM
Atlanta, GA · On-site
Refer cases that do not meet criteria and cannot be approved by InterQual criteria or nursing judgment to a Referral Nurse Coordinator who in turn assures review by a Peer Review Consultant on any ...
Review Nurse-PA/UM
Atlanta, GA · On-site
Refer cases that do not meet criteria and cannot be approved by InterQual criteria or nursing judgment to a Referral Nurse Coordinator who in turn assures review by a Peer Review Consultant on any ...
Quick apply
Review Nurse-PA/UM
Atlanta, GA · On-site
Refer cases that do not meet criteria and cannot be approved by InterQual criteria or nursing judgment to a Referral Nurse Coordinator who in turn assures review by a Peer Review Consultant on any ...
RN - Care Manager
Fayetteville, 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 ...
RN - Care Manager
Fayetteville, 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 ...
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 ...
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 ...
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 ...
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 ...
Review Nurse-PA/UM
Atlanta, GA · On-site
Refer cases that do not meet criteria and cannot be approved by InterQual criteria or nursing judgment to a Referral Nurse Coordinator who in turn assures review by a Peer Review Consultant on any ...
Review Nurse-PA/UM
Atlanta, GA · On-site
Refer cases that do not meet criteria and cannot be approved by InterQual criteria or nursing judgment to a Referral Nurse Coordinator who in turn assures review by a Peer Review Consultant on any ...
Utilization Review Nurse
Alpharetta, GA · On-site
Assess medical necessity using established clinical guidelines such as InterQual, MCG (Milliman Care Guidelines), and payer-specific criteria.Review medical records, physician documentation ...
New
Utilization Review Nurse
Alpharetta, GA · On-site
Assess medical necessity using established clinical guidelines such as InterQual, MCG (Milliman Care Guidelines), and payer-specific criteria.Review medical records, physician documentation ...
New
... InterQual and/or Milliman). * 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare ...
... InterQual and/or Milliman). * 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare ...
... InterQual and/or Milliman). * 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare ...
... InterQual and/or Milliman). * 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare ...
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 ...
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 ...
... InterQual and/or Milliman). * 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare ...
... InterQual and/or Milliman). * 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare ...
Effectively promote Care Management practices as they relate to the use of software, e.g., InterQual, and IT systems, leveraging for information / data collection, analysis and reporting. * Monitor ...
Effectively promote Care Management practices as they relate to the use of software, e.g., InterQual, and IT systems, leveraging for information / data collection, analysis and reporting. * Monitor ...
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:
Piedmont Healthcare rating
7.1
Based on 466 frontline employees who took The Breakroom Quiz
378th of 887 rated healthcare providers
Job description
Overview
Experience the advantages of real career change
Join Piedmont to move your career in the right direction. Stay for the diverse teams you'll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You'll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.
Responsibilities
The Care Manager is responsible for care coordination, progression of care, and proactive discharge planning and is accountable for expediting the timely and safe discharge for all patients in their case load.
Qualifications
Education
Work Experience
Licenses and Certifications
Business Unit : Company Name
Piedmont Augusta Hospital
Experience the advantages of real career change
Join Piedmont to move your career in the right direction. Stay for the diverse teams you'll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You'll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.
Responsibilities
The Care Manager is responsible for care coordination, progression of care, and proactive discharge planning and is accountable for expediting the timely and safe discharge for all patients in their case load.
Qualifications
Education
- Graduate of Nursing Program Required
- Master's degree Preferred
Work Experience
- 2 years of experience in an acute or post-acute setting Required
- 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 Care Management Preferred
Business Unit : Company Name
Piedmont Augusta Hospital
What Piedmont Healthcare employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Piedmont
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Atlanta, GA, US
Year founded
1905