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Interqual information

What are the typical daily responsibilities of someone working with InterQual criteria in a healthcare setting?

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, and why are they important?

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 job?

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 Tennessee? The most popular types of Interqual jobs in Tennessee are:
What are popular job titles related to Interqual jobs in Tennessee? For Interqual jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Interqual jobs in Tennessee look for? The top searched job categories for Interqual jobs in Tennessee are:
What cities in Tennessee are hiring for Interqual jobs? Cities in Tennessee with the most Interqual job openings:
Interqual jobs near you
Infographic showing various Interqual job openings in Tennessee as of July 2026, with employment types broken down into 7% As Needed, and 93% Full Time. Highlights an 72% In-person, 9% Hybrid, and 19% Remote job distribution.
RN-Case Manager

RN-Case Manager

Baptist Memorial Health Care Corporation

Collierville, TN

Other

Posted 20 days ago

Baptist Memorial Health Care rating

7.2

Company rating: 7.2 out of 10

Based on 112 frontline employees who took The Breakroom Quiz

334th of 890 rated healthcare providers

Job description

Job Summary

Case Managers will apply systems, science, incentives, and information to improve healthcare practice and assist patients and their support systems to become engaged in a collaborative process designed to manage medical/social/mental health conditions more effectively. The case manager's objective is to achieve an optimal level of wellness for patients and improve coordination of care while providing cost effective, non-duplicative services. Performs all other duties as assigned.

Responsibilities

  • Assess and document the clinical, psychosocial and financial needs of patients including availability of care support, risk for readmission and safe environment upon discharge/transition and payor benefits. Findings are collected by interviewing patients, caregivers and members of the interdisciplinary team. Aspects of this assessment obtained from the patient record or previous case manager assessment are validated, updated and influence the plan of care. Assess and document the patient's care management and potential discharge needs. 20 %
  • Apply InterQual to determine/validate Level of Service and Intensity of Care. Utilize InterQual criteria within the first 24 hours of arrival to complete an initial review. Collaborate with physicians, Manager of Case Management and physician advisors to resolve conflicts. Coordinate with bed control to attain proper placement. Perform concurrent reviews of medical records to ensure continued appropriateness and make recommendations based on the needs of the patient. Escalate and facilitate resolution of unjustifiable aspects of care that vary from InterQual guidelines. 20 %
  • With the physician, identify the plan of care, estimated length of stay and transition/discharge plan. Meet with patients and families to engage them in the plan and obtain agreement. Incorporate all processes and procedures into the plan to ensure safe discharge/transition. Coordinate with physician and nurse to make plan adjustments as patient condition indicates. Use best practices and available pathways to anticipate the course of care through discharge/transition. Incorporate ancillary services as needed. Work in collaboration with social work for complex postacute placement and community service resources. 20 %
  • In coordination with nursing, ancillary departments, social work, and the physician, monitor and ensure the treatment plan and steps to prepare for transition or discharge are completed as planned, gaps in care are avoided as well as duplicative or unnecessary services. 10 %
  • Ensure that patients are discharged/transitioned timely and appropriately and that variances from the plan or target discharge/transition date are documented. 10 %
  • Escalate concerns and barriers to appropriate treatment or transition as outlined by the department. 10 %
  • Maintain a working knowledge of facilities and resources available to patients and caregivers. 10 %

Specifications

Experience

Minimum Required

  • 3 years Healthcare/Medical-Acute Care Required.

Preferred/Desired

  • Healthcare/Medical-Case Manager Preferred, or Healthcare/Medical - Utilization Review Preferred.

Education

Minimum Required

  • Graduate of School of Nursing-Accredited Required.

Preferred/Desired

  • Bachelor's Degree Nursing Preferred, or Bachelor's Degree Allied Health Preferred.

Training

Minimum Required

Preferred/Desired

Special Skills

Minimum Required

  • Must be able to work with acutely & chronically ill patients of all ages and their caregivers. Must have excellent interpersonal communication, multi-tasking, prioritizing & organizational skills. Demonstrated ability to work effectively with teams in a collaborative manner and escalate issues appropriately. Ability to work weekends and flexible hours per the department staffing plan.

Preferred/Desired

Licensure

Minimum Required

  • License/Certification/Registries (valid for the State of MS): Registered Nurse (RN) by the State Board of Nursing Required.

Preferred/Desired

  • Certification by the Case Management Society of America Preferred, or Equivalent Certification Preferred.

What Baptist Memorial Health Care employees say

Pay

Benefits

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About Baptist Memorial

Sourced by ZipRecruiter

Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Memphis, TN, US

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