, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific...
criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual...
, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, Medicaid/Medicare..., Milliman guidelines, InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Required Licenses...
- Clinical experience in hospital or medical office/clinic setting. Experience with Milliman criteria. Preferred...
BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
and/or Milliman criteria Evaluate medical necessity, level of care, and documentation accuracy Ensure compliance with Medicare...) Experience with InterQual (must be able to pass exam) Experience with Milliman guidelines Preferred Background in Case...
, conflict resolution skills and assertive communication skills required. Knowledge of InterQual ISD-A and Milliman Guidelines...
. Assess medical necessity and intensity of services using the Milliman and Interqual Criteria. Conduct insurance notification...
preferred. Experience in use of Milliman/InterQual criteria. General Skills: Essential computer skills. If you're...