, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. Collaborates with clinical teams...
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...
review;InterQual and Milliman experience required Technical Skills: Proficiency with Microsoft Outlook, Word...
of recognized industry clinical standards, i.e. Interqual, Milliman Care Guidelines. Maintain the highest level of customer...
, Milliman, MCG, and similar guidelines required. Credentials: Licensed to practice medicine in the State of Florida...
REQUIRED Experience: Related experience- 3 years Health Plan OR Utilization Management experience preferred JIVA and Milliman Care..., Utilization Review, Medical Necessity, JIVA, Milliman...
Management Proficiency with Milliman Care Guidelines or Interqual Bilingual skills to communicate effectively with patients...
Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts...
;Utilize InterQual Criteria;Utilize Milliman Guidelines;UR Admission Criteria;UR Appeals and Denials;UR Concurrent Review... Milliman Guidelines;CMS: Centers for Medicare and Medicaid Services;CPT (Current Procedural Terminology) coding and billing...