Advantage and/or Medicaid (CDPS Rx, Milliman, Mercer), Quality (HEDIS / STARS) measure performance, Population Health including...
Health, or Business from an accredited college or university is preferred. Prior experience using Milliman or InterQual...
functions. 1. Standard office environment SKILLS AND ABILITIES: 1. Working Knowledge of InterQual and/or Milliman Care...
field preferred. Current BCLS certificate preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred...
(AHA) certificate upon hire and maintain current. Knowledge of Milliman Criteria and InterQual Criteria preferred...
of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer skills...
in the medical record according to policy guidelines. Utilizes MCG- Milliman criteria to identify severity of illness...
., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria). Examine and evaluate patient...
Utilization Management for assigned patients. Applies Milliman Care Guidelines (Indicia) criteria to monitor appropriateness...
using InterQual or Milliman Preferred Licenses and Certifications Current unrestricted registered nurse (RN) license...