of Milliman Criteria and InterQual Criteria preferred. 6. Experience and knowledge in basic to intermediate computer skills...
(Milliman, InterQual, CMS NCD / LCD) to conduct objective medical necessity reviews and make appeal determination... authorizations. Experience with the application of clinical criteria (i.e., Milliman, InterQual, Apollo, CMS National and Local...
requirements for production actuarial models in Integrate Manage and strengthen vendor relationships, including Milliman...
. Reviews clinical against Milliman criteria to help determine patient class and level of care needed. Confers with MD...
exam. Recent documented experience with Milliman experience....
of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria). Examine and evaluate...
. Knowledge of Milliman Criteria and InterQual Criteria preferred. Pay Transparency: St. Mary's General Hospital...
Assignment of appropriate levels of care Completion of all required documentation in Milliman and EPIC Collaborates.... Completes utilization management and quality screening for assigned patients. Applies Milliman Criteria to monitor...
of terminology CPT codes and ICD 10 Bilingual preferred Knowledge of InterQual or Milliman Care Guidelines preferred Minimum...
in any of the following is a strong preference: Milliman HCG data, Power BI, claims-based experience analysis, trend analysis...