and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred Pay Range: USD $45.09 - USD $56.39 /Hr....
is responsible for managing appeal processes, reviewing and understanding clinical guidelines (like Milliman/InterQual... of care (inpatient, observation, outpatient). Applies clinical guidelines (InterQual/Milliman) to validate medical necessity...
Current BLS (AHA) certificate Knowledge of Milliman Criteria and InterQual Criteria Full benefits at Prime Healthcare...
, Utilization, Billing, and coding review;InterQual and Milliman experience required Technical Skills: Proficiency with Microsoft...
experience, preferred. 5. Experience in psychiatric emergency and triage preferred. 6. Knowledge of Milliman Criteria...
or Tableau Actuarial domain familiarity or modeling platform experience (GGY AXIS, Milliman Integrate) Why This Role Stands...
of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
support or sponsorship from Milliman now or in the future. Milliman’s CMH Health Practice is seeking a Senior Health Policy... We Are Milliman is one of the leading experts in healthcare financing and delivery. We advise clients on a wide range of issues...
, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. Collaborates with clinical teams...
management. 2. Current Standards of Care & Criteria, working knowledge of Intequal and/or Milliman. 3. Ability to train...