, 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...
for medical necessity across inpatient and outpatient services, applying CMS guidelines and Milliman Care Guidelines (MCG... in determinations of referrals and utilize Milliman Care Guidelines (MCG) to assist in determinations of referrals. 3. Maintain goals...
of terminology CPT codes and ICD 10 Bilingual preferred Knowledge of InterQual or Milliman Care Guidelines preferred Minimum...
. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
or insurance setting Experience applying Medicare and/or Medicaid guidelines Experience with Milliman (MCG) or InterQual...
BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
. Apply Milliman Care Guidelines and payer-specific criteria to determine appropriate patient status. Collaborate with attending...
claims analytics tools (such as Milliman MedInsight) • Knowledge of and experience with electronic health records...
- Clinical experience in hospital or medical office/clinic setting. Experience with Milliman criteria. Preferred...
management training is required. DRG Assignment and Interqual and/or Milliman is preferred. SPECIAL SKILLS...