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PSNYC , INC.

RN - Case Manager

Alexandria, LA

Must have: candidates without these skills will not be considered for the role Case Management experience Midas/InterQual use Licensed Masters Preferred or nice to have: candidates with these skills ...

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How much do interqual jobs pay per year?

As of May 31, 2026, the average yearly pay for interqual in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

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 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 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.
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Interqual jobs near you
Infographic showing various Interqual job openings in the United States as of May 2026, with employment types broken down into 6% As Needed, 71% Full Time, 15% Part Time, and 8% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Registered Nurse (RN) - Utilization Management / Review - 26-06292

NavitasPartners

Clay, NY • On-site

$60/hr

Full-time

Posted yesterday

Job description

Registered Nurse (RN) – Utilization Management / Review

Location - Syracuse, NY

Duration - 14 Weeks

Position Type: Contract

Short Description

Seeking an experienced Registered Nurse (RN) with strong knowledge of utilization management, hospital admission criteria, and healthcare payer regulations. Preferred experience includes working with MCG or InterQual screening criteria, CMS regulations, and interfacing with healthcare payers and regulatory agencies.

Job Summary

The Registered Nurse (RN) will support utilization management and review activities to ensure appropriate patient care, regulatory compliance, and effective coordination with healthcare payers and interdisciplinary care teams.

The ideal candidate will possess strong clinical assessment skills, knowledge of hospital admission criteria, and experience working in acute care environments. This role requires strong communication skills, attention to detail, and the ability to work independently within a fast-paced healthcare setting.

Key Responsibilities
  • Review patient cases for medical necessity and appropriate level of care determination
  • Utilize screening criteria tools such as:
    • MCG
    • InterQual
  • Ensure compliance with CMS regulations and hospital admission guidelines
  • Coordinate with healthcare payers, regulatory agencies, physicians, and care teams
  • Support utilization review and case management activities
  • Maintain accurate and timely documentation within the electronic medical record system
  • Communicate effectively with interdisciplinary healthcare teams regarding patient status and care plans
  • Assist in identifying opportunities for process improvement and regulatory compliance
  • Provide high-quality patient-centered support while maintaining confidentiality and accuracy
Required Qualifications
  • Current New York State Registered Nurse (RN) registration/license
  • Current BLS Certification and ability to maintain certification
  • Minimum 1.5 years of recent acute care experience within the past 2 years
  • Experience working in hospitals of similar or greater size and acuity
  • Strong interpersonal and communication skills
  • Legal authorization to work in the United States
  • Must successfully pass pre-employment health clearance, drug screening, and background check
Preferred Qualifications
  • Experience with:
    • MCG screening criteria
    • InterQual criteria
    • CMS regulations related to hospital admissions
    • Utilization Management or Utilization Review
    • Interfacing with healthcare payers and regulatory agencies
  • Experience with EPIC Electronic Medical Records preferred
  • Experience in Level 1 Trauma hospitals highly preferred
Required Skills
  • Strong clinical assessment and decision-making skills
  • Knowledge of utilization management processes and regulatory requirements
  • Excellent documentation and organizational skills
  • Ability to work independently with minimal supervision
  • Strong communication and collaboration skills
  • Attention to detail and accuracy in case review processes

For more details reach at sthakur@navitashealth.com or Call / Text at 732 791 4807 - EXT 4807.