of clinical experience as a NP or PA Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines...
of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual...
to come in with it. 5–8 years of relevant experience at a Medicare Advantage health plan or actuarial/consulting firm (Milliman, Wakely...
the patient's admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman...
BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
for ongoing InterQual/Milliman compliance, quality improvement, and utilization review per CMS guidelines and hospital policy...
nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria...
on preventing and appealing denials and educates on medical necessity criteria such as InterQual and/or Milliman Care Guidelines...
’ clinical presentation against Milliman Care Guidelines (MCG) to identify admission status, working DRG and target...