years of acute care nursing experience. preferred CCM or obtained within 1year Knowledge of Milliman Criteria...
. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
Required Required Experience using InterQual or Milliman Required Licenses and Certifications Licensure or eligible for licensure, in the state...
. Work with Milliman MedInsight data structures to support payer-provider analytics and efficiency benchmarking. Build... claims). Hands-on experience with Milliman MedInsight data models and analytics workflows. Strong SQL and data modeling...
or Milliman criteria Travel Requirement:No regular travel is expected. Occasional onsite presence for audits or key meetings...
of Milliman Care Guidelines, preferred. Experience working with the Medicare and Medicaid population segment, preferred...
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...
;Managed Care, NYSDOH and OMH guidelines;Milliman Care Guidelines and community resources. - LMSW/LCSW - MSW in Social...