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Manager Interqual Jobs in Riverside, CA (NOW HIRING)

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

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 ...

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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

Utilization Review RN

Prime Healthcare

Ontario, CA • On-site

$71K - $104K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 16 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 283 frontline employees who took The Breakroom Quiz

641st of 887 rated healthcare providers

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities

Responsible for the quality and resource management of all authorizations and referrals with the Prime Healthcare Employee EPO. 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 insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

  • Minimum 7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license.

  • Minimum 3 years RN Utilization Manager working for a Health Plan.

  • At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals.

  • Current BCLS (AHA) certificate upon hire and maintain current.

  • Knowledge of MCG Criteria and/or InterQual Criteria required.

  • Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:

  • Five years acute care nursing experience preferred.

  • Experience with self-funded health plan preferred.

Pay Transparency

Prime Healthcare 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. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $104,000.00 on an annualized basis. 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 Status

Full Time

Shift

Days

Equal 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

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FacilityPrime Healthcare Management Inc

LocationUS-CA-Ontario

ID2026-273521

CategoryRN

Position TypeFull Time

ShiftDays

Job TypeExempt

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