Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred. LICENSURE/CERTIFICATION Current licensure as a Registered Nurse with the Texas State Board of Nurse ...
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred. LICENSURE/CERTIFICATION Current licensure as a Registered Nurse with the Texas State Board of Nurse ...
Knowledge of ODG, MTUS, Milliman Care Guidelines, InterQual (preferred)
Knowledge of ODG, MTUS, Milliman Care Guidelines, InterQual (preferred)
... InterQual (preferred)
... InterQual (preferred)
... InterQual (preferred)
... InterQual (preferred)
InterQual, MCG, or payer-specific medical necessity criteria. * CMS Conditions of Participation (where applicable). * DNV NIAHO Behavioral Health standards. * Validate appropriate level of care ...
InterQual, MCG, or payer-specific medical necessity criteria. * CMS Conditions of Participation (where applicable). * DNV NIAHO Behavioral Health standards. * Validate appropriate level of care ...
Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance. * Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier ...
Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance. * Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance. * Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier ...
Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance. * Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier ...
Registered Nurse (RN) - Acute Care Case Management - $27-49 per hour
Arlington, TX · On-site
$27 - $49/hr
InterQual experience preferred Benefits Medical City Arlington, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
Registered Nurse (RN) - Acute Care Case Management - $27-49 per hour
Arlington, TX · On-site
$27 - $49/hr
InterQual experience preferred Benefits Medical City Arlington, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
RN Case Manager
Dallas, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
RN Case Manager
Dallas, TX · On-site
InterQual experience preferred Benefits Medical City Dallas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs ...
RN Case Manager PRN
Lewisville, TX · On-site
InterQual experience preferred Benefits Medical City Lewisville, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
New
RN Case Manager PRN
Lewisville, TX · On-site
InterQual experience preferred Benefits Medical City Lewisville, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
New
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
Experience in use of InterQual and or Milliman criteria and review processes highly desirable. * Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to ...
RN Case Manager PRN
Lewisville, TX · On-site
InterQual experience preferred Benefits Medical City Lewisville, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
RN Case Manager PRN
Lewisville, TX · On-site
InterQual experience preferred Benefits Medical City Lewisville, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
RN Case Manager
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
New
RN Case Manager
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
New
RN Case Manager
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
RN Case Manager
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
RN Case Manager
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
RN Case Manager
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
RN Case Manager PRN
Lewisville, TX · On-site
InterQual experience preferred Benefits Medical City Lewisville, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
RN Case Manager PRN
Lewisville, TX · On-site
InterQual experience preferred Benefits Medical City Lewisville, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and ...
RN Case Manager
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
RN Case Manager
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
RN Case Manager in Plano, TX
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
RN Case Manager in Plano, TX
Plano, TX · On-site
Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established ...
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 Texas? The most popular types of Interqual jobs in Texas are:
What are popular job titles related to Interqual jobs in Texas? For Interqual jobs in Texas, the most frequently searched job titles are:
- No Experience Utilization Management Nurse
- Director Of Facilities Management Healthcare
- Manager Utilization Management
- Rn Utilization Management
- Work From Home Pre Admission Testing Rn
- Evening Optum Health Utilization Review
- Manager Care Management
- Per Diem Travel Rn
- Evening Remote Telephonic Nurse Case Manager
- Night Utilization Review Nurse
What job categories do people searching Interqual jobs in Texas look for? The top searched job categories for Interqual jobs in Texas are:
What cities in Texas are hiring for Interqual jobs? Cities in Texas with the most Interqual job openings:
University Of Nevada (Reno) rating
8.5
Based on 18 frontline employees who took The Breakroom Quiz
80th of 617 rated colleges and universities
Job description
POSITION SUMMARY/RESPONSIBILITIES
Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.
EDUCATION/EXPERIENCE
Registered Nurse (RN) is required. Bachelor of Science in Nursing (BSN) or Master’s degree is preferred. Minimum three (3) years nursing, acute care, quality management or managed care experience is required. Basic knowledge of Medicaid, Medicare, community resources and alternate funding programs is desired. Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred.
LICENSURE/CERTIFICATION
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. Current certification from an appropriate professional agency, such as Case Management Society, is preferred.
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