The UR Nurse reviews medical necessity, authorizes services using InterQual criteria , coordinates ... managed care utilization review experience preferred About PRIDE Health PRIDE Health is the ...
The UR Nurse reviews medical necessity, authorizes services using InterQual criteria , coordinates ... managed care utilization review experience preferred About PRIDE Health PRIDE Health is the ...
RN Case Manager (Urgent required)
Washington, DC · On-site
$2.2K - $2.3K/wk
RN Case Manager - Washington, DC Duration: 13 weeks Shift: Day (5×8 hrs) | 08:00 AM - 04:30 PM We ... Utilizing InterQual Criteria * Utilizing Milliman Guidelines * Previous Charge Nurse experience ...
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RN Case Manager (Urgent required)
Washington, DC · On-site
$2.2K - $2.3K/wk
RN Case Manager - Washington, DC Duration: 13 weeks Shift: Day (5×8 hrs) | 08:00 AM - 04:30 PM We ... Utilizing InterQual Criteria * Utilizing Milliman Guidelines * Previous Charge Nurse experience ...
Director Utilization Management MedStar Family Choice
Washington, DC · On-site
$120K - $238K/yr
InterQual ASAM) and internal policies. * Leads workforce planning and staffing models to ensure appropriate caseload distribution and productivity standards. * Supervises and develops UM managers and ...
Director Utilization Management MedStar Family Choice
Washington, DC · On-site
$120K - $238K/yr
InterQual ASAM) and internal policies. * Leads workforce planning and staffing models to ensure appropriate caseload distribution and productivity standards. * Supervises and develops UM managers and ...
Nurse Reviewer
Annapolis Junction, MD · On-site
$40 - $70/hr
Document findings and decisions in patient management systems. * Stay current with clinical guidelines (e.g., InterQual, Milliman, CMS) and healthcare regulations. Qualifications * Active RN license ...
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Nurse Reviewer
Annapolis Junction, MD · On-site
$40 - $70/hr
Document findings and decisions in patient management systems. * Stay current with clinical guidelines (e.g., InterQual, Milliman, CMS) and healthcare regulations. Qualifications * Active RN license ...
New
Case Manager - Part Time
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 ...
Case Manager - Part Time
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 ...
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:
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:
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:
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:
... 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 ...
... 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 ...
... 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 ...
... 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 ...
... 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 ...
... 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 ...
... 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 ...
... 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 ...
Make a lasting impact as a Care Manager supporting Medicaid members across DC. Use your clinical ... Knowledge of tools like InterQual or JIVA * Passion for Medicaid populations and purpose-driven ...
Make a lasting impact as a Care Manager supporting Medicaid members across DC. Use your clinical ... Knowledge of tools like InterQual or JIVA * Passion for Medicaid populations and purpose-driven ...
Make a lasting impact as a Care Manager supporting Medicaid members across DC. Use your clinical ... Knowledge of tools like InterQual or JIVA * Passion for Medicaid populations and purpose-driven ...
Make a lasting impact as a Care Manager supporting Medicaid members across DC. Use your clinical ... Knowledge of tools like InterQual or JIVA * Passion for Medicaid populations and purpose-driven ...
... 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 ...
... 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 ...
... 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 ...
... 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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Case Manager (RN) - PRN/Supplemental
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 ...
Case Manager (RN) - PRN/Supplemental
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 ...
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?
| Aspect | Manager Interqual | Clinical Case Manager |
|---|---|---|
| Credentials | Typically requires nursing or healthcare management certifications | Requires nursing or social work licensure and clinical experience |
| Work Environment | Healthcare organizations, utilization review departments | Hospitals, insurance companies, community health settings |
| Primary Focus | Utilization management, policy implementation, and compliance | Patient 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 are 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.
What are the most commonly searched types of Interqual jobs in Washington? The most popular types of Interqual jobs in Washington are:
Contractor
Medical, Dental, Vision, Life, Retirement
Posted 12 days ago
Job description
PRIDE Health is seeking a travel nurse RN Care Manager for a travel nursing job in Hanover, Maryland.
Job Description & Requirements- Specialty: Care Manager
- Discipline: RN
- Start Date: 08/10/2026
- Duration: 8 weeks
- 40 hours per week
- Shift: 8 hours, days
- Employment Type: Travel
This is a 54-day remote assignment for an experienced Utilization Review (UR) Registered Nurse. This is a non-clinical, medical review position with no direct patient care. The UR Nurse reviews medical necessity, authorizes services using InterQual criteria, coordinates discharge planning, and collaborates with providers and Medical Directors to ensure appropriate, cost-effective care.
Schedule- 🏠 100% Remote
- 🗓 Monday–Friday
- ⏰ 8:00 AM – 4:30 PM (EST)
- 📞 No call
- 🚫 No weekends or holidays
- 📅 54-day contract (approximately 8 weeks)
- ✅ Active Registered Nurse (RN) license
- ✅ 5+ years of RN experience
- ✅ Current Utilization Review (UR) experience
- ✅ EPIC experience
- ✅ Proficiency using InterQual criteria/software
- ⭐ At least 1 year of managed care utilization review experience preferred
PRIDE Health is the minority-owned healthcare recruitment division of Pride Global—an integrated human capital solutions and advisory firm. With our robust and abundant travel nursing and allied health employment options across the U.S., PRIDE Health will allow you to help change the way the world lives and heals as it connects you with the industry’s leading healthcare organizations.
Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.
- Weekly pay
- Holiday Pay
- Guaranteed Hours
- 401k retirement plan
- Cancelation protection
- Referral bonus
- Medical benefits
- Dental benefits
- Vision benefits
About PRIDE Health
Sourced by ZipRecruiter
PRIDE Health is the minority-owned healthcare recruitment division of Pride Global--an integrated human capital solutions and advisory firm. With our robust and abundant travel nursing and allied health employment options across the U.S., PRIDE Health will allow you to help change the way the world lives and heals as it connects you with the industry's leading healthcare organizations.
Industry
Recruiting and staffing services
Company size
51 - 200 Employees
Headquarters location
New York, NY, US
Year founded
2010