of Milliman Care Guidelines, preferred. Experience working with the Medicare and Medicaid population segment, preferred...
Skills: Experience and/or knowledge of Interqual/Milliman guidelines (MCG) clinical criteria Experience with CMS...
limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines...
or nursing management, preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Behavioral Violence...
of Milliman Care Guidelines, preferred. Experience working with the Medicare and Medicaid population segment, preferred...
and pharmacy claims data. Work with Milliman MedInsight data models for payer-provider analytics and benchmarking. Develop... data Payer-provider analytics Milliman MedInsight (preferred) Education & Experience Bachelor’s or Master’s degree...
utilization review using Milliman Guidelines to support appropriate care decisions Collaborate with multidisciplinary teams... Knowledge & Skills Strong knowledge of case management and utilization review processes Familiarity with Milliman Guidelines...
, document, and follow individualized plans of care using Epic and Milliman guidelines Serve as the liaison between patients... and ordering DME Using Milliman guidelines for utilization decisions Proficient Epic charting and electronic documentation...
Experience 2 years of experience in an acute or post-acute setting Required Experience using InterQual or Milliman Preferred...
of utilization review experience is highly preferred Experience using Interqual or Milliman is highly preferred At least 1-2 years...