Care Review Clinician
Troy, MI · On-site
Will be an inpatient UM, get cases from hospitals, review info about patient, enter info into computer system (interqual, or MCG) determine if it meets criteria, work with medical director for ...
Troy, MI · On-site
Will be an inpatient UM, get cases from hospitals, review info about patient, enter info into computer system (interqual, or MCG) determine if it meets criteria, work with medical director for ...
Troy, MI · On-site
Will be an inpatient UM, get cases from hospitals, review info about patient, enter info into computer system (interqual, or MCG) determine if it meets criteria, work with medical director for ...
Troy, MI · On-site
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 ...
Troy, MI · On-site
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 ...
You will also review the CPTs that were boarded for meeting inpatient on the CMS inpatient list and the InterQual inpatient list based on payer criteria used. Hours are Monday - Friday from 830am ...
You will also review the CPTs that were boarded for meeting inpatient on the CMS inpatient list and the InterQual inpatient list based on payer criteria used. Hours are Monday - Friday from 830am ...
McKesson InterQual experience preferred. Business planning experience preferred. 4. Accredited Case Manager (ACM) preferred.
McKesson InterQual experience preferred. Business planning experience preferred. 4. Accredited Case Manager (ACM) preferred.
McKesson InterQual ® experience preferred. Business planning experience preferred. 4. Accredited Case Manager (ACM) preferred. Central Business Solutions, Inc(A Certified Minority Owned Organization ...
McKesson InterQual ® experience preferred. Business planning experience preferred. 4. Accredited Case Manager (ACM) preferred. Central Business Solutions, Inc(A Certified Minority Owned Organization ...
You will also review the CPTs that were boarded for meeting inpatient on the CMS inpatient list and the InterQual inpatient list based on payer criteria used. Hours are Monday - Friday from 830am ...
You will also review the CPTs that were boarded for meeting inpatient on the CMS inpatient list and the InterQual inpatient list based on payer criteria used. Hours are Monday - Friday from 830am ...
Detroit, MI · On-site
McKesson InterQual experience preferred. Business planning experience preferred. 4. Accredited Case Manager (ACM) preferred. Skills Required 1. Analytical ability to serve in an advisory/consultative ...
Detroit, MI · On-site
McKesson InterQual experience preferred. Business planning experience preferred. 4. Accredited Case Manager (ACM) preferred. Skills Required 1. Analytical ability to serve in an advisory/consultative ...
Detroit, MI · On-site +1
$30 - $35/hr
Should have experience with InterQual Requirement: * Bachelor's degree in nursing, allied health, business, or related field preferred. * Two to four years of clinical experience which may include ...
Detroit, MI · On-site +1
$30 - $35/hr
Should have experience with InterQual Requirement: * Bachelor's degree in nursing, allied health, business, or related field preferred. * Two to four years of clinical experience which may include ...
M-F 8:30 am to 5 pm Will be an inpatient UM, get cases from hospitals, review info about patient, enter info into computer system (interqual, or MCG) determine if it meets criteria, work with medical ...
M-F 8:30 am to 5 pm Will be an inpatient UM, get cases from hospitals, review info about patient, enter info into computer system (interqual, or MCG) determine if it meets criteria, work with medical ...
Experience facilitating InterQual reviews, admission process preferred. Experience with systems that support patient flow, admission, and transfer preferred. Ability to prioritize, meet deadlines and ...
Experience facilitating InterQual reviews, admission process preferred. Experience with systems that support patient flow, admission, and transfer preferred. Ability to prioritize, meet deadlines and ...
Familiarity with MCG/InterQual placement status criteria is preferred. * Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or the ...
Familiarity with MCG/InterQual placement status criteria is preferred. * Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or the ...
Familiarity with MCG/InterQual placement status criteria is preferred. * Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or the ...
Familiarity with MCG/InterQual placement status criteria is preferred. * Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or the ...
Experience facilitating InterQual reviews, admission process preferred. Experience with systems that support patient flow, admission, and transfer preferred. Ability to prioritize, meet deadlines and ...
Experience facilitating InterQual reviews, admission process preferred. Experience with systems that support patient flow, admission, and transfer preferred. Ability to prioritize, meet deadlines and ...
Southfield, MI · On-site
$26.50 - $31/hr
We are targeting nurses with: * experience with peer review, clinical documentation review, or medical necessity assessments. * familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer ...
Southfield, MI · On-site
$26.50 - $31/hr
We are targeting nurses with: * experience with peer review, clinical documentation review, or medical necessity assessments. * familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer ...
Southfield, MI · Remote
$26.50 - $31/hr
We are targeting nurses with: * experience with peer review, clinical documentation review, or medical necessity assessments. * familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer ...
Southfield, MI · Remote
$26.50 - $31/hr
We are targeting nurses with: * experience with peer review, clinical documentation review, or medical necessity assessments. * familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer ...
Detroit, MI · On-site
Familiarity with MCG/InterQual placement status criteria is preferred. * Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or the ...
Detroit, MI · On-site
Familiarity with MCG/InterQual placement status criteria is preferred. * Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or the ...
Southfield, MI · Remote
$26.50 - $31/hr
We are targeting nurses with: * experience with peer review, clinical documentation review, or medical necessity assessments. * familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer ...
Southfield, MI · Remote
$26.50 - $31/hr
We are targeting nurses with: * experience with peer review, clinical documentation review, or medical necessity assessments. * familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer ...
$33 - $37/hr
Interqual or Milliman (MCG) experience * Other basic computer skills necessary: Microsoft Office, Data Entry, etc. * Minimum 2-4 years of clinical practice. Additional Information Hours: Mon-Fri 8 ...
$33 - $37/hr
Interqual or Milliman (MCG) experience * Other basic computer skills necessary: Microsoft Office, Data Entry, etc. * Minimum 2-4 years of clinical practice. Additional Information Hours: Mon-Fri 8 ...
... Interqual Experience preferred Additional Information If you are interested in applying to this position, please click "I'm Interested" or contact Heather Dumet
... Interqual Experience preferred Additional Information If you are interested in applying to this position, please click "I'm Interested" or contact Heather Dumet
Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience (at least one year) Registered Nurse in the state of Michigan Additional ...
Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience (at least one year) Registered Nurse in the state of Michigan Additional ...
$34K - $43.8K
15% of jobs
$43.8K - $53.6K
8% of jobs
$55K is the 25th percentile. Wages below this are outliers.
$53.6K - $63.5K
15% of jobs
The median wage is $69.7K / yr.
$63.5K - $73.3K
20% of jobs
$73.3K - $83.1K
11% of jobs
$88K is the 75th percentile. Wages above this are outliers.
$83.1K - $92.9K
13% of jobs
$92.9K - $102.8K
5% of jobs
$102.8K - $112.6K
3% of jobs
$112.6K - $122.4K
4% of jobs
$122.4K - $132.2K
3% of jobs
$132.2K - $142.1K
3% of jobs
$34K
$78K
$142.1K
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.
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.
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.
Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.
Location: Troy, MI
Shift: M-F 8:30 am to 5 pm
Duties:
Will be an inpatient UM, get cases from hospitals, review info about patient, enter info into computer system (interqual, or MCG) determine if it meets criteria, work with medical director for approval, notify Hospital of approval. Follow members from admission process all the way through to discharge, find discharge plan and where patient is being discharged to.
Top 3 Skills:
Strong Communication both verbal and written
Attention to detail
Computer skills
Must Haves:
UM experience
Computer skills
Licensed RN in the state of Michigan.
Nice to Have:
Familiar with interqual or MCG software
Kind Regards,
Kavita Kumari
Clinical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
DIRECT # - 732-844-8726
Sourced by ZipRecruiter
Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.
Recruiting and staffing services
51 - 200 Employees
Edison, NJ, US
1996