and knowledge in basic to intermediate computer skills. 1. Current BCLS certificate preferred. 2. Knowledge of Milliman Criteria...
and knowledge in basic to intermediate computer skills. 1. Current BCLS certificate preferred. 2. Knowledge of Milliman Criteria...
required, but Bachelor’s degree preferred. Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual...
for medical necessity across inpatient and outpatient services, applying CMS guidelines and Milliman Care Guidelines (MCG... (LCD, NCD) to assist in determinations of referrals and utilize Milliman Care Guidelines (MCG) to assist in determinations...
: Experience: Required: Minimum 3 years of general case management skills. Minimum of two years of experience utilizing Milliman...
or current multi state license required. Effective Jan 2026: Current MCG (Milliman Clinical Guideline) certification...
-A and Milliman Guidelines and third party insurance requirements preferred. Experience in gathering information, monitoring...
requirements Understanding of CPT and HCPCS coding guidelines Expertise with InterQual and Milliman disease management ideologies...
by referencing regulatory mandates, contracts, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM (American...
using InterQual or Milliman Preferred Licenses and Certifications RN - Registered Nurse - Georgia State Licensure...