required Knowledge of Medicaid and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred...
in Benefit Point. Capable of Gathering and Analyzing ICAF, Milliman, Aggregate and DMW reports. Initiate own correspondence...
of experience in an acute or post-acute setting Required Experience using InterQual or Milliman Preferred Licenses...
-making criteria sets (i.e., Milliman, InterQual) Minimum of one year of experience with medical management activities...
for improvement referring outliers to peer review. ·Reviews medical records for ongoing InterQual/Milliman compliance, quality...
Committee for improvement referring outliers to peer review. · Reviews medical records for ongoing InterQual/Milliman...
, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems Pay is based on several factors including...
for admission, observation, and level of care to comply with federal and state mandates. Uses Milliman and Medicare...
, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems Pay is based on several factors including...
about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems Pay...