to other involved healthcare entities. Duties and Responsibilities Screens calls for admissions against Milliman Care Guidelines.../process/role, needs assessment, principles of utilization review/quality assurance, use of Milliman or other clinical decision...
criteria (i.e. MCG (formally Milliman), InterQual, Centers for Medicare and Medicaid), FHCP Protocols, and the Member’s FHCP...
. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
management, preferred. 4. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
or similar setting Proven awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid...
and/or Medicaid guidelines Experience with Milliman (MCG) or InterQual guidelines Experience researching and preparing clinical...
-authorization experience Utilization Management experience Case Management experience Knowledge of Milliman Criteria Certified...
of clinical experience as a NP or PA Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines...
, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems Pay is based on several factors including...