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Manager Interqual Jobs in Virginia (NOW HIRING)

Carillion Clinic

RN Case Manager - Weekdays

Roanoke, VA · On-site

Uses InterQual software to support accurate patient statuses according to ongoing medical necessity ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

UVA Health

Physician Advisor (Remote)

Manassas, VA · Remote

$250K - $350K/yr

Perform medical necessity reviews using MCG and/or InterQual * Support CMS compliance, including the 2-Midnight Rule and inpatient status determinations * Partner with Case Management, CDI, and ...

Astyra Corporation

Integrated Care Manager

Richmond, VA · Remote

$38 - $42/hr

As an Integrated Care Manager , you'll use your clinical expertise to coordinate care across ... Familiarity with InterQual and/or ASAM guidelines * Basic proficiency with Microsoft Office Why ...

New

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Uses InterQual software to support accurate patient statuses according to ongoing medical necessity ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Uses InterQual software to support accurate patient statuses according to ongoing medical necessity ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Uses InterQual software to support accurate patient statuses according to ongoing medical necessity ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carillion Clinic

RN Case Manager

Roanoke, VA · On-site

Uses InterQual software to support accurate patient statuses according to ongoing medical necessity ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

$76K - $115K/yr

Provides care management for assigned patient populations, utilizing clinical expertise ... InterQual. * Coordinates with patients and families to ensure understanding of discharge plans ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Uses InterQual software to support accurate patient statuses according to ongoing medical necessity ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Uses InterQual software to support accurate patient statuses according to ongoing medical necessity ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager - Weekdays

Roanoke, VA · On-site

Uses InterQual software to support accurate patient statuses according to ongoing medical necessity ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

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Manager Interqual information

How does a Manager Interqual typically collaborate with clinical and administrative teams to ensure effective utilization review?

A Manager Interqual works closely with both clinical staff—such as physicians, nurses, and case managers—and administrative teams to implement and oversee the use of InterQual criteria in utilization review processes. They facilitate training, address questions about criteria application, and help resolve discrepancies between clinical recommendations and insurance requirements. Regular meetings and interdisciplinary rounds are common, ensuring that patient care decisions are well-documented and meet regulatory standards. This collaborative approach helps streamline approvals, reduce denials, and maintain high-quality patient care.

What is the difference between Manager Interqual vs Clinical Case Manager?

AspectManager InterqualClinical Case Manager
CredentialsTypically requires nursing or healthcare management certificationsRequires nursing or social work licensure and clinical experience
Work EnvironmentHealthcare organizations, utilization review departmentsHospitals, insurance companies, community health settings
Primary FocusUtilization management, policy implementation, and compliancePatient advocacy, care coordination, and discharge planning

The Manager Interqual primarily oversees utilization review processes and policy adherence within healthcare organizations, often requiring management experience and specific certifications. In contrast, the Clinical Case Manager focuses on direct patient care, coordinating services, and ensuring appropriate treatment. Both roles are vital in healthcare but serve different functions related to patient care and resource management.

What are the key skills and qualifications needed to thrive as a Manager Interqual, and why are they important?

To excel as a Manager Interqual, you need a solid background in healthcare management, clinical guidelines, and utilization review processes, typically supported by a nursing or clinical degree and relevant experience. Familiarity with InterQual criteria, case management software, and healthcare compliance systems is crucial. Strong leadership, analytical thinking, and effective communication are valuable soft skills for guiding teams and collaborating with diverse stakeholders. These competencies ensure proper application of clinical criteria, optimize resource utilization, and support quality patient care and regulatory compliance.

What is a Manager Interqual?

A Manager Interqual is a healthcare management professional responsible for overseeing the use and implementation of the InterQual criteria within a healthcare organization. InterQual is a set of evidence-based clinical decision support tools used to ensure appropriate hospital admissions, continued stays, and other medical services. The Manager Interqual leads teams that review cases for medical necessity, ensures compliance with regulatory requirements, and collaborates with clinical staff to optimize patient care and resource utilization. They also provide training on InterQual standards and help integrate these criteria into hospital processes.
Manager Interqual jobs near you

Physician Advisor, UVA Health Physician Advisor (Remote)

UVA Health System

Manassas, VA • Remote

$250K - $350K/yr

Full-time

Posted 9 days ago

Job description

Physician Advisor (Remote)

Opportunity

UVA Health is seeking an experienced Physician Advisor to provide physician leadership across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case Management. This remote role focuses on medical necessity, regulatory compliance, documentation improvement, and advancing quality and operational outcomes. Join a dedicated and collaborative team that is valued by health system leadership for this unique skillset.

Key Responsibilities

  • Perform medical necessity reviews using MCG and/or InterQual
  • Support CMS compliance, including the 2-Midnight Rule and inpatient status determinations
  • Partner with Case Management, CDI, and physician teams to improve documentation and patient flow
  • Provide physician education, documentation feedback, and CDI query support
  • Conduct peer-to-peer reviews and assist with denial prevention and appeals
  • Participate in quality, compliance, and operational improvement initiatives

Position Highlights

  • Fully remote physician leadership opportunity (with the exception of 4 on-site meetings per year that are 1-day meetings)
  • Collaborate with multidisciplinary teams across UVA Health
  • Improve clinical documentation, utilization practices, and patient outcomes
  • Help shape system-wide initiatives in quality, compliance, and stewardship

Qualifications

  • MD or DO
  • Board Certified in Family Medicine, Internal Medicine or Pediatrics
  • Eligible for Virginia medical licensure
  • Prior Utilization Management experience preferred
  • Knowledge of CMS regulations and MCG/InterQual guidelines
  • Excellent communication and collaboration skills

The base compensation range for this role is $250,000 - $350,000 for a 1.0 clinical FTE status.

Individual compensation will be determined by fair market value and the selected candidates qualifications, clinical experience, specialty training, credentials, and/or education. Please note that the pay range does not include any applicable incentive compensation programs, such as productivity, quality, non-productivity, or other incentives that may be available for eligible positions. 

We are equal opportunity employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex, pregnancy, sexual orientation, veteran or military status, and family medical or genetic information.

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