: Certification in Case or Care Management;experience using InterQual or Milliman;Master?s degree preferred. Business Unit...
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...
. Fully insured experience preferred. Intermediate Excel experience preferred. Milliman experience preferred. Job Level...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
, 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...
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...
. Additional Qualifications That Are a Plus: Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience...