against InterQual, MCG, or Milliman criteria. Support physician advisor workflows, peer-to-peer review requests, and denial appeals... preferred. Hands-on knowledge of InterQual, MCG, or Milliman clinical review criteria. Familiarity with CMS Two-Midnight Rule...
with prior experience at: Property & Casualty insurance carriers Insurance consulting firms (e.g., Perr & Knight, Milliman...
teams to coordinate patient care plans Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review... utilization review, case management, or managed care experience strongly preferred Familiarity with InterQual or Milliman...
required, but Bachelor’s degree preferred. Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual...
. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria...
and/or Milliman Care Guidelines 2. Demonstrated knowledge of federal and state laws, NCQA and industry regulations related...
. Knowledge of Milliman (MCG) criteria. PRI/screen certification. PHYSICAL WORKING CONDITIONS Sitting in a comfortable position... to assess clinical and discharge needs of orthopedic surgical patients. Knowledge of Milliman (MCG) criteria. PRI/screen...