with Interqual or Milliman guidelines and use. Proficient in process improvement, and performance monitoring. Required Work...
compliance with applicable criteria, medical policy, member eligibility, benefits and vendor contracts. Apply Milliman Care... in Case Management a plus Proficient in application and use of industry standard Utilization Management criteria (Milliman...
, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. Collaborates with clinical teams...
upon hire and maintain current;Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge...
is a subsidiary of Milliman;a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare..., Marketing, Finance, and Milliman partners. Key Objectives of the Role Own and grow a defined book of business with clear...
standards (InterQual and Milliman). Conduct admission, concurrent, and length-of-stay reviews and communicate with payors...
and maintain current;Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic...
Registry Utilization Review Nurse (PRN) is responsible for conducting medical necessity reviews by utilizing Milliman...
necessity reviews by utilizing Milliman and Interqual Guidelines in conjunction with a review of the patient chart, clinical...
LOS to other disciplines for timely discharge planning. Provides timely clinical reviews to Third party Payers utilizing Milliman guidelines... planning/quality assurance/infection control. Knowledge of Milliman guidelines and Interqual criteria. Understanding EPIC...