;Discharge Planning;Utilize InterQual Criteria;Utilize Milliman Guidelines;UR Admission Criteria;UR Appeals and Denials;UR... Utilize Milliman Guidelines;CMS: Centers for Medicare and Medicaid Services;CPT (Current Procedural Terminology) coding...
in the medical record according to policy guidelines. Utilizes MCG- Milliman criteria to identify severity of illness...
Sharp Health Plan Medical Policies in conjunction with Milliman Care Guidelines for medical necessity approvals...
and Milliman Care Guidelines. Knowledge of DRG and GMLOS, Managed Care and Regulatory Requirements preferred. Knowledge...
Utilization Management for assigned patients. a) Applies Milliman Care Guidelines (Indicia) criteria to monitor appropriateness...
to other involved healthcare entities. Duties and Responsibilities Screens calls for admissions against Milliman Care Guidelines.../process/role, needs assessment, principles of utilization review/quality assurance, use of Milliman or other clinical decision...
criteria (i.e. MCG (formally Milliman), InterQual, Centers for Medicare and Medicaid), FHCP Protocols, and the Member’s FHCP...
management, preferred. 4. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria...
. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...