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Interqual Jobs in Chicago, IL (NOW HIRING)

achn

UM RN Reviewer

Chicago, IL · On-site

Perform medical necessity reviews using InterQual and/or other medical decision support software designated by the organization and rendering determinations appropriately within established ...

Med-Metrix

Physician Advisor - Remote

Chicago, IL · On-site +1

Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable

Saint Joseph Medical Center - Joliet

Case Manager

Joliet, IL · On-site

$35.35 - $53.58/hr

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 ...

Prime Healthcare

Director of Case Management

Chicago, IL · On-site

$100K - $135K/yr

Preferred qualifications: 1. CCM or obtained within 1year 2. BS or BSN or related field preferred. 3. Current BCLS certificate preferred. 4. Knowledge of Milliman Criteria and InterQual Criteria ...

Prime Healthcare

Case Manager

Joliet, IL · On-site

$35.35 - $53.58/hr

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 ...

Prime Healthcare

RN Case Manager Social Worker

Chicago, IL · On-site

$35.35 - $47.58/hr

Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate, preferred Pay Transparency Resurrection Medical Center offers competitive compensation and a comprehensive ...

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All JobsInterqual JobsInterqual Jobs in Chicago, IL

Interqual information

See Chicago, IL salary details

$40.2K

$92.2K

$167.9K

How much do interqual jobs pay per year?

As of Aug 10, 2026, the average yearly pay for interqual in Chicago, IL is $92,180.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,400.00 and $107,600.00 per year, depending on experience, location, and employer.

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 Chicago, IL? The most popular types of Interqual jobs in Chicago, IL are:
What are popular job titles related to Interqual jobs in Chicago, IL? For Interqual jobs in Chicago, IL, the most frequently searched job titles are:
What job categories do people searching Interqual jobs in Chicago, IL look for? The top searched job categories for Interqual jobs in Chicago, IL are:
Interqual jobs near you
Infographic showing various Interqual job openings in Chicago, IL as of August 2026, with employment types broken down into 4% As Needed, 69% Full Time, 13% Part Time, and 14% Contract. Highlights an 85% In-person, 2% Hybrid, and 13% Remote job distribution, with an average salary of $92,180 per year, or $44.3 per hour.

UM RN Reviewer

achn

Chicago, IL • On-site

Other

Posted 26 days ago

Job description

Core Job Responsibilities 

  1. Perform medical necessity reviews using InterQual and/or other medical decision support software designated by the organization and rendering determinations appropriately within established regulatory timeframes.
  2. Accurately documents required information into necessary systems according to department documentation standards and following all department workflows including correspondence to members and providers (ie. PCP notification of inpatient admissions). Documentation of discharge planning within 24 to 48 hours of admission notification.
  3. Completes admission authorization, out of network transfers, initiates concurrent authorization, completes retrospective authorization and minimizes financial risk by maintaining timely communication with all payors.
  4. Generates and process daily admission logs and appropriate denial letters as per UM process.
  5. Performs critical analysis of decisions/determinations while supporting effective team collaboration and communication.
  6. Assist with audit processes.
  7. Must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations.
  8. Coordinates with the Case Management/Care Coordination nurses to ensure members who are eligible for case management are identified and enrolled as well as to ensure contact post hospital discharge.
  9. Works closely with the health center staff, providers, hospitals, MCOS, and other outside vendors concerning scope of benefits, referrals, precertification/authorizations, and network facility participation.
  10. Participate in department committee meetings, webinars, training, projects and special assignments for cross-coverage purposes to meet strict authorization processing deadlines.
  11. Other duties as assigned.

Requirements/Preferences

  1. Associate required; Bachelors (Preferred); Registered Nurse (RN); current licensure in Illinois
  2. Minimum 1-year nursing experience inpatient or ambulatory (Preferred)
  3. Minimum 1-year Utilization Management experience preferred
  4. Minimum 1-year Case management experience preferred
  5. Experience with Epic System (EHR), InterQual a plus
  6. Intermediate proficiency in Microsoft Office products

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