of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
) in accordance with Milliman Care Guidelines (MCG). The Case Manager assists in coordination of care among multidisciplinary team... of service) within forty-eight hours of admission Knowledge of Milliman Care Guidelines Knowledge of CMS guidelines for post...
guidelines (e.g., InterQual, Milliman Clinical Guidelines) to determine appropriate status determination and support appeal...
requires in-depth knowledge of utilization management principles, including Milliman and Robertson criteria, medical...
recognized evidence-based utilization review criteria (such as Milliman Care Guidelines (MCG) or InterQual) to determine...
in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care... and Milliman guidelines. Act as a liaison between the medical staff, utilization review and third-party payers to effectively...
/ Order DME Plan of Care Pre-Cert Review* Prior Authorizations* Utilize InterQual Criteria* Utilize Milliman Guidelines...
as needed. Utilize InterQual and Milliman guidelines for utilization review. Maintain accurate documentation in Epic. Ensure compliance...
abilities. Ability to work collaboratively across all levels of the organization. Knowledge of InterQual or Milliman Care...
department or system-wide patient flow Assesses patients’ clinical presentation against Milliman Care Guidelines (MCG...