-A and Milliman Guidelines and third party insurance requirements preferred. Experience in gathering information, monitoring...
Applies Interqual (McKesson)/Milliman or other facility endorsed in- and out-patient evidence-based programs to monitor Length... to apply Interqual/Milliman as well as other evidence based guidelines addressing entitlements and LOD. Must have knowledge of relevant...
or nursing management, preferred. Current BCLS (AHA) certificate upon hire and maintain current;. Knowledge of Milliman...
;. Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer...
/Management required Experience with CCM, ACM, or Milliman preferred BLS required upon submission...
/Management required Experience with CCM, ACM, or Milliman preferred BLS required upon submission...
QUALIFICATIONS: Experience in a pediatric acute hospital Familiarity with Interqual or Milliman Care Guidelines Experience...
the patient's admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman...
to come in with it. 5–8 years of relevant experience at a Medicare Advantage health plan or actuarial/consulting firm (Milliman, Wakely...
on preventing and appealing denials and educates on medical necessity criteria such as InterQual and/or Milliman Care Guidelines...