Case Manager RN
Garden City, MI · On-site
Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate, preferred Employment StatusPer DiemShiftDaysEqual Employment Opportunity Company is an equal employment ...
Garden City, MI · On-site
Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate, preferred Employment StatusPer DiemShiftDaysEqual Employment Opportunity Company is an equal employment ...
Garden City, MI · On-site
Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate, preferred Employment StatusPer DiemShiftDaysEqual Employment Opportunity Company is an equal employment ...
Troy, MI · On-site
Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry, etc. Minimum ...
Troy, MI · On-site
Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry, etc. Minimum ...
Garden City, MI · On-site
Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate, preferred Employment StatusPer DiemShiftDaysEqual Employment Opportunity Company is an equal employment ...
Garden City, MI · On-site
Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate, preferred Employment StatusPer DiemShiftDaysEqual Employment Opportunity Company is an equal employment ...
Preferred Qualifications: 4. Five years of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria preferred. 7. Current BCLS ...
Preferred Qualifications: 4. Five years of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria preferred. 7. Current BCLS ...
Garden City, MI · On-site
Preferred Qualifications: 4. Five years of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria preferred. 7. Current BCLS ...
Garden City, MI · On-site
Preferred Qualifications: 4. Five years of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria preferred. 7. Current BCLS ...
Preferred Qualifications: 4. Five years of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria preferred. 7. Current BCLS ...
Preferred Qualifications: 4. Five years of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria preferred. 7. Current BCLS ...
Garden City, MI · On-site
Preferred Qualifications: 4. Five years of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria preferred. 7. Current BCLS ...
Garden City, MI · On-site
Preferred Qualifications: 4. Five years of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria preferred. 7. Current BCLS ...
Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry ...
Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry ...
Detroit, MI · On-site
Basic knowledge of evidence-based clinical decision support guidelines (InterQual). * Basic knowledge of CPT coding and guidelines. * Other related skills and/or abilities may be required to perform ...
Detroit, MI · On-site
Basic knowledge of evidence-based clinical decision support guidelines (InterQual). * Basic knowledge of CPT coding and guidelines. * Other related skills and/or abilities may be required to perform ...
Qualifications Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft ...
Qualifications Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft ...
Detroit, MI · On-site
Basic knowledge of evidence-based clinical decision support guidelines (InterQual). * Basic knowledge of CPT coding and guidelines. * Other related skills and/or abilities may be required to perform ...
Detroit, MI · On-site
Basic knowledge of evidence-based clinical decision support guidelines (InterQual). * Basic knowledge of CPT coding and guidelines. * Other related skills and/or abilities may be required to perform ...
Troy, MI · On-site
$33 - $37/hr
Interqual experience (at least one year) * Also has a background in patient, skilled nurses facilities, rehab, and home healthcare. * Other basic computer skills necessary: Microsoft Office, Data ...
Troy, MI · On-site
$33 - $37/hr
Interqual experience (at least one year) * Also has a background in patient, skilled nurses facilities, rehab, and home healthcare. * Other basic computer skills necessary: Microsoft Office, Data ...
$70K - $95K/yr
Conducts clinical reviews using Interqual criteria to determine appropriate patient level of care, document medical necessity, and support reimbursement. * Monitors resource utilization through ...
$70K - $95K/yr
Conducts clinical reviews using Interqual criteria to determine appropriate patient level of care, document medical necessity, and support reimbursement. * Monitors resource utilization through ...
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 ...
Ann Arbor, MI · Remote
$29.05 - $67.97/hr
Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal ...
Ann Arbor, MI · Remote
$29.05 - $67.97/hr
Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal ...
Detroit, MI · Remote
$29.05 - $67.97/hr
Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal ...
Detroit, MI · Remote
$29.05 - $67.97/hr
Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal ...
$16.75 - $21.75/hr
Demonstrates working knowledge and application of Interqual criteria. * Works effectively with medical staff to optimize appropriate resource management. * Advocates for patients with payers to ...
$16.75 - $21.75/hr
Demonstrates working knowledge and application of Interqual criteria. * Works effectively with medical staff to optimize appropriate resource management. * Advocates for patients with payers to ...
Sterling Heights, MI · Remote
$29.05 - $67.97/hr
Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal ...
Sterling Heights, MI · Remote
$29.05 - $67.97/hr
Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal ...
... InterQual/MCG criteria proficiency. • Support audit readiness and consistency of responses to pre-payment and post-payment reviews, including complex payer or regulatory audits. Collaboration ...
... InterQual/MCG criteria proficiency. • Support audit readiness and consistency of responses to pre-payment and post-payment reviews, including complex payer or regulatory audits. Collaboration ...
$103K - $155K/yr
Support training initiatives related to InterQual criteria, documentation standards, and patient throughput processes * Foster a culture of collaboration, accountability, and continuous improvement ...
$103K - $155K/yr
Support training initiatives related to InterQual criteria, documentation standards, and patient throughput processes * Foster a culture of collaboration, accountability, and continuous improvement ...
$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.
6.2
Based on 6 frontline employees who took The Breakroom Quiz
776th of 999 rated hospitals
Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Garden City Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.
At Garden City Hospital, we pride ourselves on community involvement and commitment to preserving access to quality and compassionate healthcare. We are a state-of-the-art medical facility with over 300 licensed beds and a teaching hospital, offering medical education to students, residents and fellows from across the country. The residency and fellowship programs offer graduate medical education to more than 80 trainees in specialties. Garden City Hospital has an award-winning staff of over 350 of the area's best and brightest physicians from almost every specialty. Learn more at www.gch.org.
ResponsibilitiesResponsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
QualificationsEDUCATION, EXPERIENCE, TRAINING
Required Qualifications:
1. Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license2. At least one year experience in case management, discharge planning or nursing management3. Experience and knowledge in basic to intermediate computer skills.Preferred Qualifications:
4. Five years of acute care nursing experience. preferred5. CCM or obtained within 1year6. Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate, preferred
Employment StatusPer DiemShiftDaysEqual Employment OpportunityCompany is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Employment Type: CONTRACTORSourced by ZipRecruiter
Health care and social assistance
1,001 - 5,000 Employees
Garden City, MI, US
1947