limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines...
License Experience: 1-3 years of experience in Case Review, Utilization, Billing, and coding review;InterQual and Milliman...
of Milliman Care Guidelines, preferred. Experience working with the Medicare and Medicaid population segment, preferred...
(AHA) certificate, preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge...
or nursing management, preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Behavioral Violence...
limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines...
of Milliman Care Guidelines, preferred. Experience working with the Medicare and Medicaid population segment, preferred...
and pharmacy claims data. Work with Milliman MedInsight data models for payer-provider analytics and benchmarking. Develop... data Payer-provider analytics Milliman MedInsight (preferred) Education & Experience Bachelor’s or Master’s degree...
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...
using InterQual or Milliman Preferred Licenses and Certifications RN - Registered Nurse - Georgia State Licensure...