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Interqual Jobs in Chicago, IL (NOW HIRING)

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

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 ...

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Interqual information

See Chicago, IL salary details

$40.2K

$92.2K

$167.9K

How much do interqual jobs pay per year?

As of Aug 30, 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 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 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 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $92,180 per year, or $44.3 per hour.

Physician Advisor - Remote

Med-Metrix

Chicago, IL • On-site, Remote

Contractor

Re-posted 6 days ago

Med-Metrix rating

6.9

Company rating: 6.9 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

289th of 499 rated business services

Job description

Job Purpose
The Physician Advisor performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor works closely with the Client's medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to recommend methods to optimize use of hospital services for all patients. This includes identifying opportunities to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.
Duties and Responsibilities
  • Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a timely fashion
  • Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management
  • 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
  • Maintains accountability for achieving case management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care
  • Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment
  • Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested
  • Meets productivity and quality standards within established time requirements. Work product and performance meets or exceeds quality standards.
  • Achieve performance goals as outlined in employment agreement
  • Maintains confidentiality of patient care and business matters
  • Demonstrates behavior that supports the organization's mission. Participates in required orientation and training related to the Physician Advisor role
  • Demonstrates commitment to meeting/exceeding strategic initiatives of organization
  • Upholds the organization's values of teamwork and professionalism and applies Code of Conduct standards to all members of the healthcare team
  • Facilitate, mentor, and educate other physicians regarding payer requirements
  • Attends all meetings as requested by PAOC leadership
  • Participate in the peer review process as may be necessary or requested
  • Maintain medical licensure and board certification in good standing
  • During scheduled work hours, commits full attention to Physician Advisory and execution of outlined tasks
  • Other duties as assigned
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Understand and comply with Information Security and HIPAA policies and procedures at all times
  • Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications
  • Board Certified and licensed to practice medicine in the US or 3+ years active clinical experience in the US
  • 3+ years working as a Physician Advisor performing Level of care reviews as well as Peer to Peer Reviews
  • Basic technical skills with Hospital EMRs a must
  • Hold and maintain an unrestricted medical license and Board Certification
  • Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety
  • Possess a working knowledge of (Hospital) organization & case management operations and administrative standards and policies
  • Familiarity with MCG/InterQual placement status criteria is preferred
  • Member of the American College of Physician Advisors (ACPA) preferred
  • Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred
  • Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred
  • Able to effectively present information, both formal and informal
  • Strong analytical skills
  • Proficiency in Microsoft Office Suite
  • Strong interpersonal skills, ability to communicate well at all levels of the organization
  • Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
  • High level of integrity and dependability with a strong sense of urgency and results oriented
  • Excellent written and verbal communication skills required

Working Conditions
  • This role requires availability to provide a minimum of 16 shifts per month. Each shift is 6-8 hours in duration and includes 2 weekend shifts per month.
  • Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
  • Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
  • Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
  • Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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