recognized evidence-based utilization review criteria (such as Milliman Care Guidelines (MCG) or InterQual) to determine...
requires in-depth knowledge of utilization management principles, including Milliman and Robertson criteria, medical...
in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care... and Milliman guidelines. Act as a liaison between the medical staff, utilization review and third-party payers to effectively...
as needed. Utilize InterQual and Milliman guidelines for utilization review. Maintain accurate documentation in Epic. Ensure compliance...
/ Order DME Plan of Care Pre-Cert Review* Prior Authorizations* Utilize InterQual Criteria* Utilize Milliman Guidelines...
abilities. Ability to work collaboratively across all levels of the organization. Knowledge of InterQual or Milliman Care...
) · Milliman experience (preferred) · Knowledge of NCQA (preferred) · Microsoft suite (Word, Excel, Outlook) (preferred... Management, Milliman, NCQA We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits...
management activities. Familiarity with established clinical decision-support criteria, such as InterQual and Milliman...
: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA The...
management activities. Familiarity with established clinical decision-support criteria, such as InterQual and Milliman...