of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
and creation of new tools, and development of marketing materials. Maintain relationship with Milliman in support of claims trends... to support Self-insured reconciliations, including managing financial relationship with Milliman in support of our contract...
or insurance setting Experience applying Medicare and/or Medicaid guidelines Experience with Milliman (MCG) or InterQual...
functions. 1. Standard office environment SKILLS AND ABILITIES: 1. Working Knowledge of InterQual and/or Milliman Care...
members on concepts as needed. Provide training on DRG & Clinical Validation, Short Stay, to include Milliman, InterQual...
limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines...
Experience 2 years of experience in an acute or post-acute setting Required Experience using InterQual or Milliman Preferred...
. Ability to work independently, setting priorities to coordinate care plans efficiently. Working knowledge of Milliman...
, conflict resolution skills and assertive communication skills required. Knowledge of InterQual ISD-A and Milliman Guidelines...
team Assignment of appropriate levels of care Completion of all required documentation in Milliman and EPIC... in appropriate setting. Completes utilization management and quality screening for assigned patients. Applies Milliman...