That Are a Plus: Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer...
of service Demonstrates the ability to interpret InterQual and Milliman and Roberts criteria to ensure the patients meet...
of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
) in accordance with Milliman Care Guidelines (MCG). The Case Manager assists in coordination of care among multidisciplinary team... of service) within forty-eight hours of admission Knowledge of Milliman Care Guidelines Knowledge of CMS guidelines for post...
guidelines (e.g., InterQual, Milliman Clinical Guidelines) to determine appropriate status determination and support appeal...
recognized evidence-based utilization review criteria (such as Milliman Care Guidelines (MCG) or InterQual) to determine...
requires in-depth knowledge of utilization management principles, including Milliman and Robertson criteria, medical...
in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care... and Milliman guidelines. Act as a liaison between the medical staff, utilization review and third-party payers to effectively...
as needed. Utilize InterQual and Milliman guidelines for utilization review. Maintain accurate documentation in Epic. Ensure compliance...
/ Order DME Plan of Care Pre-Cert Review* Prior Authorizations* Utilize InterQual Criteria* Utilize Milliman Guidelines...