and/or Medicaid guidelines Experience with Milliman (MCG) or InterQual guidelines Experience researching and preparing clinical...
or similar setting Proven awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid...
, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems Pay is based on several factors including...
-authorization experience Utilization Management experience Case Management experience Knowledge of Milliman Criteria Certified...
of clinical experience as a NP or PA Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines...
organization Experience in a telephonic role Knowledge of Interqual or Milliman guidelines (MCG) *All employees working...
or similar setting Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare...
Utilization Management for assigned patients. Applies Milliman Care Guidelines (Indicia) criteria to monitor appropriateness...
, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific...
(within past 3 years) working knowledge of Milliman Care Guidelines, preferred. Minimum of three years (3) in clinical medical...