Required Experience using InterQual or Milliman Preferred Licenses and Certifications Current unrestricted registered nurse (RN...
(AHA) certificate, preferred Knowledge of Milliman Criteria and InterQual Criteria preferred Experience and knowledge...
for admission, observation, and level of care to comply with federal and state mandates. Uses Milliman and Medicare...
Case Management Experience Familiarity with AllScripts Care Management Proficiency with Milliman Care Guidelines...
InterQual or Milliman/MCG criteria to validate patient status decisions and payer medical necessity compliance. Reviews medical...
guidelines, InterQual, Milliman, or similar criteria Experience in hospital or payer-facing environments Bachelor of Science...
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 BCLS certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
Interqual or Milliman required High level of competency performing medical necessity reviews with accepted criteria required...
. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...