(s) utilizing InterQual (IQ), Milliman Care Guidelines (MCG), or in accordance with CMS rules and regulations for medical necessity... and clinical data. Responsible for yearly re-education on industry standard criteria, i.e., InterQual/Milliman Care Guidelines...
but not required. Experience: Five years of related experience required. Knowledge of InterQual, Milliman, MCG, and similar guidelines...
with InterQual or Milliman Guidelines. Essential Functions Census and rounds Reviews every patient under assigned workload...
years of experience in an acute or post-acute setting Required Experience using InterQual or Milliman Preferred Licenses...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
and/or Medicare regulations requiredKnowledge of Milliman criteria (MCG) preferredFor UM Only: Experience must be with a Managed Care...
care management experience is preferred. Experience in the use of InterQual/Milliman criteria preferred. Basic computer...
Required Experience using InterQual or Milliman Preferred Licenses and Certifications Current unrestricted registered nurse (RN...
in Benefit Point. Capable of Gathering and Analyzing ICAF, Milliman, Aggregate and DMW reports. Initiate own correspondence...
/Milliman/DMW – Gather Data necessary and submit to carriers. Compile information for Sr. Account Consultant/Executive Team Lead...