or current multi state license required. Effective Jan 2026: Current MCG (Milliman Clinical Guideline) certification...
certificate preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Employment Status Full Time Shift...
and interfacility transfers. Apply knowledge of safe discharge, medical necessity, utilization review, InterQual/Milliman, EMTALA..., InterQual/Milliman criteria, EMTALA/COBRA, and healthcare reimbursement processes. Schedule: This is a hybrid role...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
, etc. Knowledge of descriptive statistical techniques. Knowledge of reporting tools, for example Excel, Milliman – MedInsight...
Experience 2 years of experience in an acute or post-acute setting Required Experience using InterQual or Milliman Preferred...
-REQUIRED Preferred Qualifications Bachelor's Degree in Nursing Experience with Milliman Care Guidelines (MCG) Experience...
required Knowledge of Medicaid and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred...
in any of the following is a strong preference: Milliman HCG data, Power BI, claims-based experience analysis, trend analysis...
. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding benefits...