. Ability to work independently, setting priorities to coordinate care plans efficiently. Working knowledge of Milliman...
, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, Medicaid/Medicare...
of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
Current BLS (AHA) certificate Knowledge of Milliman Criteria Full benefits at Prime Healthcare: #LI-MP1 Employment...
within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status...
guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems Pay is based on several factors including...
Current BLS (AHA) certificate Knowledge of Milliman Criteria and InterQual Criteria Full benefits at Prime Healthcare...
management skills. Minimum of two years of experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation...
-Current Version (CPT) coding;and McKesson (InterQual) and/or Milliman Care Guidelines. Life Support Certifications...
required Knowledge of Medicaid and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred...