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...
’ clinical presentation against Milliman Care Guidelines (MCG) to identify admission status, working DRG and target...
-based criteria such as InterQual or Milliman Care Guidelines (MCG) to evaluate admissions, continued stays, and discharge...
-based criteria such as InterQual or Milliman Care Guidelines (MCG) to evaluate admissions, continued stays, and discharge...
-based criteria such as InterQual or Milliman Care Guidelines (MCG) to evaluate admissions, continued stays, and discharge...
of Milliman/InterQual criteria. General Skills: Essential computer skills....
in an acute or post-acute setting Required Experience using InterQual or Milliman Preferred Licenses and Certifications RN...
): Conduct thorough clinical reviews using established guidelines (such as Milliman or InterQual) to manage commercial payer... Knowledge: Hands-on experience utilizing InterQual or Milliman Criteria for utilization review. Location and Work Type Work...