Utilization Management for assigned patients. a) Applies Milliman Care Guidelines (Indicia) criteria to monitor appropriateness...
in the medical record according to policy guidelines. Utilizes MCG- Milliman criteria to identify severity of illness...
and Milliman Care Guidelines. Knowledge of DRG and GMLOS, Managed Care and Regulatory Requirements preferred. Knowledge...
Sharp Health Plan Medical Policies in conjunction with Milliman Care Guidelines for medical necessity approvals...
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...
criteria (i.e. MCG (formally Milliman), InterQual, Centers for Medicare and Medicaid), FHCP Protocols, and the Member’s FHCP...
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...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
or similar setting Proven awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid...