of Milliman Care Guidelines, preferred. Experience working with the Medicare and Medicaid population segment, preferred...
and pharmacy claims data. Work with Milliman MedInsight data models for payer-provider analytics and benchmarking. Develop... data Payer-provider analytics Milliman MedInsight (preferred) Education & Experience Bachelor’s or Master’s degree...
in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care... and Milliman guidelines. · Act as a liaison between the medical staff, utilization review and third-party payers to effectively...
;Managed Care, NYSDOH and OMH guidelines;Milliman Care Guidelines and community resources. - LMSW/LCSW - MSW in Social...
. Working with advisory councils or governance bodies. Utilizing Milliman Care Guidelines (MCG) criteria and other state...
within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status...
within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status...
regulations requiredKnowledge of Milliman criteria (MCG) preferredFor UM Only: Experience must be with a Managed Care Organization...
criteria sets and clinical pathways, such as MCG (Milliman Care Guidelines) or InterQual. (Preferred) Familiarity...
’ experience in Healthcare setting preferred Milliman Guidelines, evidence-based clinical practice, that help determine the...