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Interqual Jobs in Georgia (NOW HIRING)

Mission Hospital

RN Case Manager

Augusta, GA · On-site

InterQual experience is preferred. Benefits Doctors Hospital of Augusta , offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans ...

Memorial Satilla Health

RN Case Manager

Waycross, GA · On-site

InterQual experience is preferred. Benefits Memorial Satilla Health , offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...

Mission Hospital

RN Case Manager

Waycross, GA · On-site

InterQual experience is preferred. Benefits Memorial Satilla Health , offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...

Doctors Hospital of Augusta

RN Case Manager

Augusta, GA · On-site

InterQual experience is preferred. Benefits Doctors Hospital of Augusta , offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans ...

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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.

Registered Nurse - (RN) - ED Admission Utilization Management Experience

Northeast Georgia Health System

Gainesville, GA • On-site

Full-time

Re-posted 24 days ago

Northeast Georgia Health System rating

7.3

Company rating: 7.3 out of 10

Based on 155 frontline employees who took The Breakroom Quiz

305th of 887 rated healthcare providers

Job description

Job Category:
Nursing - Registered Nurse
Work Shift/Schedule:
8 Hr Afternoon - Evening
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
The ED Admissions Case Manager is responsible for evaluating and screening all ED admissions using screening guidelines to ensure patients are in the appropriate status and level of care based on the physician's documentation. The ED Admissions Case Manager collaborates with Physicians, patient and families, and other members of the healthcare team to ensure an appropriate plan of care and the appropriateness of services provided. The ED Admissions Case Manager provides comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs. Additionally, the ED Admissions Case Manager coordinates a team approach designed to facilitate the achievement of expected patient outcomes with appropriate transitions to the next level of care and also provides cross coverage for other ED RN Case Managers as required.
Minimum Job Qualifications
  • Licensure or other certifications: Professional RN licensure, Active GA licensure,
  • Educational Requirements: Associate degree. Graduate of an accredited school of nursing.
  • Minimum Experience: One (1) to two (2) years of experience in Utilization Management applying screening guidelines (InterQual or MCG Guidelines) or other related Case Management experience (i.e. Acute Care, Insurance Case Management, Workers Compensation). Three (3) to five (5) years of experience in direct patient care and/or case management.
  • Other:

Preferred Job Qualifications
  • Preferred Licensure or other certifications: Case Mgmt. Certification (CCM or ACM) preferred.
  • Preferred Educational Requirements: Bachelors Degree
  • Preferred Experience: Acute Care UR/CM experience preferred.
  • Other:

Job Specific and Unique Knowledge, Skills and Abilities
  • Demonstrated aptitude, clinical knowledge, and critical thinking skills in a fast-paced ED environment.
  • Working knowledge of State and Federal regulations third party/governmental payer regulatory requirements, and in and out of network coverage benefits.
  • Must demonstrate excellent observation skills, analytical thinking, problem solving abilities, and excellent written and verbal communication.
  • Proficiency with computers and software.
  • Knowledgeable of financial/reimbursement criteria as it relates to all payors.
  • Demonstrated interpersonal skills, including professionalism, being a team player, and a positive approach to situations. The position requires the ability to be self-directed.

Essential Tasks and Responsibilities
  • Determines if patients meet nationally recognized medical necessity criteria for admission/transfer into the system by performing admission by utilizing screening guidelines (InterQual/MCG) based on Physician documentation to ensure the patient is in the right Patient Class, and Level of Care
  • Coordinates appropriate patient entry into NGMC's acute beds, utilizing clinical criteria to assess medical appropriateness and patient status. Communicates directly with physicians and referring facilities to ensure collaborative practice.
  • Refers appropriate cases to physician advisors for review and status determination. Communicates with physician to obtain appropriate status order based on determination.
  • Work collaboratively with the Physician, nursing staff, and care team to ensure patients are meeting the expected length of stay and to assure a timely discharge and appropriate transition to the next level of care.
  • Communicate and coordinate with care team consistently to ensure patients are in the right status and level of care. Actively supports a customer service oriented environment to continually enhance customer satisfaction.
  • Adheres to all regulatory and DNV requirements; Knowledgeable of third party payers (PPO/HMO's) to facilitate appropriate outcomes and ensure coverage of services rendered.
  • Physician education and feedback to include guidance for status determinations and supporting documentation for medical necessity
  • Maintains confidentiality and respects patients privacy. Performs in a manner that respects HIPPA laws.
  • Contributes to the productive and effective operation of the Care Coordination area. Identifies and escalates opportunities for process improvement up the chain of command.

Area/Unit Specific Essential Tasks and Responsibilities: Emergency Department and Observation Unit (COU,EOU, MOU)
  • Provides coordination and facilitation oversight of patient care to assure required interventions occur in proper sequence and processes occur in a timely manner without delays. Identifies and acts upon potential delays in services; escalates unresolved delays to management for appropriate intervention.
  • Assess, coordinate and facilitate patient's discharge plan to assure post-acute needs are arranged and secured prior to discharge when applicable; Communicate discharge plan with Physician, patient/family, and other members of the healthcare team as appropriate; Reassess discharge plan routinely throughout patient's stay to ensure timely, safe discharge and appropriate transition to the next level of care. Provides patient/family with information regarding their plan of care, discharge and any financial responsibility of inpatient or post-hospitalization services.

Physical Demands
  • Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
  • Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
  • Vision: Moderate, Frequently 31-65% of time
  • Kneeling/Stooping/Bending: Occasionally 0-30%
  • Standing/Walking: Occasionally 0-30%
  • Pushing/Pulling: Occasionally 0-30%
  • Intensity of Work: Occasionally 0-30%
  • Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.
NGHS: Opportunities start here.
Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

What Northeast Georgia Health System employees say

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About Northeast Georgia Health System

Sourced by ZipRecruiter

Northeast Georgia Health System (NGHS) is a not-for-profit community health system dedicated to improving the health and quality of life of the people of Northeast Georgia. Through the services of a medical staff of more than 800 physicians, the residents of Northeast Georgia enjoy access to the state’s finest and most comprehensive medical services. It is our mission to improve the health of our community in all we do.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Gainesville, GA, US

Year founded

1951

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