based on evidence-based clinical guidelines, i.e. Milliman Clinical Guidelines (MCG) and InterQual Criteria. Ensures... to this role: Knowledge of medical terminology. Working knowledge of InterQual, Milliman Care Guidelines, and Coding Rules...
, government payer and/or denial rules Required InterQual and/or Milliman (MCG) experience Required Licenses and Certifications...
management, preferred. 4. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria...
. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status...
, actuarial systems (e.g., PeopleSoft GL, Triton, Milliman ALFA) data architecture, data integrations and cloud platforms Proven...
within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status...
, actuarial systems (e.g., PeopleSoft GL, Triton, Milliman ALFA) data architecture, data integrations and cloud platforms Proven...
required. Recent (within past 3 years) working knowledge of Milliman Care Guidelines, preferred. Minimum of three years (3...
required. Recent (within past 3 years) working knowledge of Milliman Care Guidelines, preferred. Minimum of three years (3...