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Manager Interqual Jobs in Washington (NOW HIRING)

Direct Staffing Inc

Rn Mgr Utilization Mgmt

Hanover, MD · On-site

Knowledge of Milliman or Interqual criteria preferred * Prior experience managing clinical staff required. IDEAL CANDIDATE * Requires a BA/BS; 5 years of experience in Health Care Management; or any ...

New

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 ...

Comagine

Clinical Reviewer DC

Washington, DC · On-site

The Clinical Reviewer position supports utilization management activities by assessing the medical ... Computer skills, InterQual, ASAM, Milliman criteria experience preferred In this role, you will:

Comagine Health

Clinical Reviewer DC

Washington, DC · On-site

The Clinical Reviewer position supports utilization management activities by assessing the medical ... Computer skills, InterQual, ASAM, Milliman criteria experience preferred In this role, you will:

Luminis Health

Case Manager (RN)

Lanham, MD · On-site

... InterQual or other agreed upon evidenced based guidelines) to promote quality care, decrease ... 4. Manages observation stay patients assertively and ensures timely testing, treatment and ...

Luminis Health

Case Manager (RN)

Lanham, MD · On-site

... InterQual or other agreed upon evidenced based guidelines) to promote quality care, decrease ... 4. Manages observation stay patients assertively and ensures timely testing, treatment and ...

Luminis Health

Case Manager (RN)

Annapolis, MD · On-site

... InterQual or other agreed upon evidenced based guidelines) to promote quality care, decrease ... 4. Manages observation stay patients assertively and ensures timely testing, treatment and ...

Luminis Health

Case Manager (RN)

Lanham, MD · On-site

$35 - $50/hr

... InterQual or other agreed upon evidenced based guidelines) to promote quality care, decrease ... 4. Manages observation stay patients assertively and ensures timely testing, treatment and ...

Luminis Health

Case Manager (RN)

Annapolis, MD · On-site

$35 - $50/hr

... InterQual or other agreed upon evidenced based guidelines) to promote quality care, decrease ... 4. Manages observation stay patients assertively and ensures timely testing, treatment and ...

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Manager Interqual information

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.

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 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 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 most commonly searched types of Interqual jobs in Washington?

The most popular types of Interqual jobs in Washington are:

Manager Interqual jobs near you
Infographic showing various Manager Interqual job openings in Washington as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Rn Mgr Utilization Mgmt

Direct Staffing Inc

Hanover, MD • On-site

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Rn Mgr Utilization Mgmt

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services. Primary duties may include, but are not limited to:

  • Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.
  • Coordinates service delivery to include member assessment of physical and psychological factors.
  • Partners with providers to establish short and long term goals that meet the members needs, functional abilities, and referral sources requirements.
  • Identifies members with potential for high risk complications.
  • Reviews benefit systems and cost benefit analysis.
  • Evaluates medical, mental health and substance abuse service for cost containment.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

  • Requires a BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
  • We need an aggressive UM manager quick with acute inpatient services including NICU, ICU, CCU and Transplants.
  • We need current high volume experience with Maryland hospitals, on straight medical conditions.
  • Current unrestricted RN license in the state of Maryland required.
  • Prior managed care or insurance experience preferred.
  • Computer literate - MS Word, Excel, Outlook
  • Knowledge of Milliman or Interqual criteria preferred
  • Prior experience managing clinical staff required.

IDEAL CANDIDATE

  • Requires a BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
  • Current unrestricted RN license in the state of Maryland required.
  • Prior managed care or insurance experience preferred.
  • Computer literate - MS Word, Excel, Outlook
  • Knowledge of Milliman or Interqual criteria preferred
  • Prior experience managing clinical staff required.

Additional Information

All your information will be kept confidential according to EEO guidelines. Direct Staffing Inc

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