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Manager Interqual Jobs in Riverside, CA (NOW HIRING)

Astiva Health, Inc

UM Nurse Reviewer

Orange, CA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization management experience with a Health Plan or Management Services Organization (MSO). * Strong knowledge of MCG, InterQual Criteria, Medicare (MCAL), and CMS guidelines. * Proficient in ...

Riverside Community Hospital

RN Case Manager

Riverside, CA · On-site

$64 - $91/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience preferred Founded in 1901, Riverside Community Hospital is a 542-bed full ... RN Case Manager opening. Our team will promptly review your application. Highly qualified ...

HCA HealthONE Mountain Ridge

RN Case Manager

Riverside, CA · On-site

$64 - $91/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

RN Case Manager Hourly Wage Estimate: $64.00 - $91.00 / hour Learn more about the benefits offered ... InterQual experience preferred Founded in 1901, Riverside Community Hospital is a 542-bed full ...

Posted today

Riverside Community Hospital

RN Case Manager

Riverside, CA · On-site

$64 - $91/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience preferred Founded in 1901, Riverside Community Hospital is a 542-bed full ... RN Case Manager opening. Our team will promptly review your application. Highly qualified ...

Vivian Health

RN Case Manager in Riverside, CA

Riverside, CA · On-site

$64 - $91/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

InterQual experience preferred Founded in 1901, Riverside Community Hospital is a 542-bed full ... RN Case Manager opening. Our team will promptly review your application. Highly qualified ...

Prime Healthcare Management Inc

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsibilities Responsible for the quality and resource management of all authorizations and ... Knowledge of MCG Criteria and/or InterQual Criteria required. * Experience and knowledge in basic ...

Prime Healthcare Management Inc

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsibilities Responsible for the quality and resource management of all authorizations and ... Knowledge of MCG Criteria and/or InterQual Criteria required. * Experience and knowledge in basic ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsible for the quality and resource management of all authorizations and referrals with the ... Knowledge of MCG Criteria and/or InterQual Criteria required. * Experience and knowledge in basic ...

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Showing results 21-40

All JobsInterqual JobsManager Interqual JobsManager Interqual Jobs in Riverside, CA

Manager Interqual information

See Riverside, CA salary details

$22

$46

$72

How much do manager interqual jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for manager interqual in Riverside, CA is $46.27, according to ZipRecruiter salary data. Most workers in this role earn between $37.12 and $53.17 per hour, depending on experience, location, and employer.

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

Case Manager (RN) - Utilization Management

Chino Valley Medical Center

Chino, CA • On-site

$43.25 - $58.21/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 14 days ago

Job description

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Chino Valley Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Chino Valley Medical Center is a 112-bed community hospital established in 1972 and centrally located in Southern California's Chino Valley. A nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. Chino Valley Medical Center is committed to serving the community's health care needs with top-rated emergency care as well as senior services, orthopedics, surgical services and more. Learn more at www.cvmc.com.

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management.  Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care.  The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness. 

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required Qualifications:

  •  Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
  • At least one year experience in case management, discharge planning or nursing management
  • Experience and knowledge in basic to intermediate computer skills.

    • Preferred Qualifications:

  • Five years of acute care nursing experience.  preferred
  • CCM or obtained within 1year
  • Knowledge of Milliman Criteria and InterQual Criteria preferred.
  • Current BCLS certificate, preferred
    • Pay Transparency

    Chino Valley Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $43.25 to $58.21. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment StatusFull TimeShiftDaysEqual Employment Opportunity

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

     Privacy Notice

    Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

    Employment Type: FULL_TIME

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