) and/or Milliman Care Guidelines. Performs prospective, concurrent, and retrospective reviews to justify medical necessity...
. Ability to work independently, setting priorities to coordinate care plans efficiently. Working knowledge of Milliman...
: Clinical screening criteria, such as InterQual and Milliman Care Guidelines (MCG) Medicare’s Prospective Payment System...
Milliman Care Guidelines) Viseo software experienced user, is preferred Required Licensures/Certifications/Registrations...
: Certification in Case or Care Management;experience using InterQual or Milliman;Master?s degree preferred. Business Unit...
of Milliman Care Guidelines, preferred. Experience working with the Medicare and Medicaid population segment, preferred...
of Milliman Care Guidelines, preferred. Experience working with the Medicare and Medicaid population segment, preferred...
or nursing management, preferred. 4. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual...