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Interqual Jobs in Canton, MI (NOW HIRING)

EPITEC

Registered Nurse-Review Analys

Detroit, MI · On-site

The ideal candidate will have a strong background in Care Management, Utilization Management, InterQual/MCG criteria, clinical training, and quality improvement . Responsibilities * Educate staff on ...

Integrated Resources INC

Registered Nurse

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 ...

KYYBA

Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

Experience with InterQual and/or MCG criteria . * Knowledge of CMS, NCQA, HIPAA, PA60 , utilization management, and clinical documentation. * Working knowledge of ICD-10 and CPT coding . Roles ...

Integrated Resources

Registered Nurse

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 ...

TH Medical

Director - Case Management

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 ...

TH Medical

Director - Case Management

Detroit, MI

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 ...

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All JobsInterqual JobsInterqual Jobs in Canton, MI

Interqual information

See Canton, MI salary details

$36.1K

$82.9K

$151.1K

How much do interqual jobs pay per year?

As of Aug 27, 2026, the average yearly pay for interqual in Canton, MI is $82,928.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,800.00 and $96,800.00 per year, depending on experience, location, and employer.

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 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 are popular job titles related to Interqual jobs in Canton, MI?

For Interqual jobs in Canton, MI, the most frequently searched job titles are:

What job categories do people searching Interqual jobs in Canton, MI look for?

The top searched job categories for Interqual jobs in Canton, MI are:

Interqual jobs near you
Infographic showing various Interqual job openings in Canton, MI as of August 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $82,928 per year, or $39.9 per hour.

Registered Nurse-Review Analys

EPITEC

Detroit, MI • On-site

Other

Medical

Posted 8 days ago

Job description

  • Location: Detroit, Michigan
  • Type: Contract
  • Job #105434
Registered Nurse (RN) Clinical Training & Quality Specialist
? Remote / Work From Home
? Michigan RN License Required
About the Opportunity
We are seeking an experienced Registered Nurse (RN) to support clinical quality, training, and utilization management initiatives in a fully remote environment. This role is responsible for staff education, quality reviews, audit coordination, training program development, and supporting accreditation and compliance efforts.
The ideal candidate will have a strong background in Care Management, Utilization Management, InterQual/MCG criteria, clinical training, and quality improvement.
Responsibilities
  • Educate staff on managed care programs, processes, systems, and departmental procedures.
  • Conduct quality reviews and audits of clinical cases.
  • Develop, maintain, and update training materials, manuals, and educational resources.
  • Mentor and support new hires throughout the onboarding and training process.
  • Collaborate with leadership and subject matter experts to identify training needs and resources.
  • Educate internal staff and external provider facilities on clinical policies, InterQual criteria, and departmental processes.
  • Create and deliver training programs and educational packages.
  • Participate in the development, testing, and implementation of new programs and systems.
  • Analyze performance data and provide recommendations for improvement.
  • Coordinate training logistics, class registration, scheduling, attendance tracking, and system access for new employees.
  • Perform and coordinate internal and external audits.
  • Support accreditation and regulatory compliance initiatives.
  • Serve as a change champion by supporting new processes, systems, and tools.
  • Travel occasionally as needed.
Required Qualifications
  • Nursing Diploma or Associate Degree in Nursing required.
  • Current, unrestricted Michigan Registered Nurse (RN) license required.
  • Minimum 5 years of experience in healthcare-related fields.
  • 3 to 5 years of experience in Care Management and/or Utilization Management.
  • Strong knowledge of utilization management processes and InterQual and/or MCG criteria.
  • Experience conducting clinical quality reviews and audits.
  • Excellent written, verbal, analytical, and organizational skills.
  • Ability to work independently and manage multiple priorities in a remote environment.
Preferred Qualifications
  • Bachelor's Degree in Nursing (BSN) or related field.
  • Case Management (CM) Certification.
  • Experience with clinical training and staff development.
Technical Skills & Knowledge
  • Microsoft Office Suite (Excel, Word, Teams)
  • SharePoint
  • Care Advance
  • Virtual Desktop Applications (VDA)
  • Electronic Health Records
  • ICD-10 and CPT Coding
  • CMS, NCQA, HIPAA, and other healthcare regulatory requirements
  • Clinical assessment and intervention methodologies
Why Apply?
  • Fully remote opportunity
  • Meaningful impact on clinical quality and staff development
  • Collaborative healthcare environment
  • Opportunity to contribute to training, compliance, and process improvement initiatives

Apply today if you are a Michigan-licensed RN with experience in Care Management, Utilization Management, training, and quality improvement.
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