an acute care setting Familiarity with Milliman or Interqual Care Guidelines is preferred Excellent communication...
of Milliman criteria (MCG) preferred For UM Only: Experience must be with a Managed Care Organization or Health Plan...
, etc. Mastery level knowledge and command of iCAF capabilities and services and Milliman capabilities and services. Developing...
and efficient prior authorization services. * Training Participate in Milliman and Hayes Technology Assessments training...
their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care...
and Responsibilities: Assesses patients’ clinical presentation against Milliman Care Guidelines (MCG) to identify admission status...
of Experience: 5+ years of experience in a clinical and business setting Software/Systems Experience: Interqual and/or Milliman...
in Benefit Point. Capable of Gathering and Analyzing ICAF, Milliman, Aggregate and DMW reports. Initiate own...
guidelines. Utilizes MCG- Milliman criteria to identify severity of illness & intensity of service for appropriate utilization...
understanding necessary to assess, review and apply criteria (e.g., Milliman guidelines, CMS criteria, medical policy, WellMed...