, and continued stays, based on the clinical documentation in the Electronic Health Record (EHR) in accordance with Milliman Care... hours of admission Knowledge of Milliman Care Guidelines Knowledge of CMS guidelines for post-acute placements...
. Additional Qualifications That Are a Plus: Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience...
of Milliman Criteria and InterQual Criteria preferred. 6. Experience and knowledge in basic to intermediate computer skills. Pay...
, continued-stay, and retrospective reviews. Manage appeals and denials. Apply InterQual criteria and Milliman Guidelines.... InterQual and Milliman Guidelines experience. Active Pennsylvania RN license required at submission. BLS certification and BSN...
for complex cases. Assists departmental staff with issues related to Milliman (or similar) guidelines, status determination...
That Are a Plus: Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer...
of service Demonstrates the ability to interpret InterQual and Milliman and Roberts criteria to ensure the patients meet...
of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
) in accordance with Milliman Care Guidelines (MCG). The Case Manager assists in coordination of care among multidisciplinary team... of service) within forty-eight hours of admission Knowledge of Milliman Care Guidelines Knowledge of CMS guidelines for post...
guidelines (e.g., InterQual, Milliman Clinical Guidelines) to determine appropriate status determination and support appeal...