required Knowledge of Medicaid and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred...
), Utilization Management (UM), OR Prior Authorization. 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines...
criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual...
License Experience: 1-3 years of experience in Case Review, Utilization, Billing, and coding review;InterQual and Milliman...
, Milliman, or Health Plan specific guidelines Collaborate with the Medical Director to ensure the integrity of adverse...
regulations as well as coverage guidelines and benefit limitations. The ability to apply Interqual/ Milliman Care Guidelines...
regulations as well as coverage guidelines and benefit limitations. The ability to apply Interqual/ Milliman Care Guidelines...
-making criteria sets (i.e., Milliman, InterQual) Minimum of one year of experience with medical management activities...
of experience in an acute or post-acute setting Required Experience using InterQual or Milliman Preferred Licenses...
for improvement referring outliers to peer review. ·Reviews medical records for ongoing InterQual/Milliman compliance, quality...