such as HCC and CDPS Familiarity with claims groupers such as Milliman's HCG Product management training or analytics product...
, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific...
, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, Medicaid/Medicare..., Milliman guidelines, InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Required Licenses...
- Clinical experience in hospital or medical office/clinic setting. Experience with Milliman criteria. Preferred...
and/or Milliman criteria Evaluate medical necessity, level of care, and documentation accuracy Ensure compliance with Medicare...) Experience with InterQual (must be able to pass exam) Experience with Milliman guidelines Preferred Background in Case...
. Assess medical necessity and intensity of services using the Milliman and Interqual Criteria. Conduct insurance notification...
preferred. Experience in use of Milliman/InterQual criteria. General Skills: Essential computer skills. If you're...
-HCC, Milliman, and comparable population risk methodologies for performance evaluation and financial measurement... with population risk models including CMS-HCC and Milliman methodologies (or equivalent). Experience analyzing healthcare claims...
programs strongly preferred. Experience in use of Milliman/InterQual criteria. General Skills: Essential computer skills...
preferred. Experience in use of Milliman/InterQual criteria. General Skills: Essential computer skills. If you're...