regarding patient care delivery systems Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines...
, applications, etc.) and Milliman care guidelines (MCGs) and standards. Knowledge of and experience with utilizing SDLC...
(AHA) certificate, preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge...
. MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. MUST HAVE 6 months of Prior Authorization...
within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status...
Previous Medicare experience a plus Utilization Management experience Milliman/MCG experience Work-At-Home Requirements...
. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
in Discharge Planning or Utilization Management Experience working with Milliman MCG or CMS guidelines Health Plan...
Manager (CCM) Familiarity with AllScripts Care Management Proficiency with Milliman Care Guidelines or Interqual Bilingual...
. Ability to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines. Ability to understand and apply coverage...