, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific...
criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual...
, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, Medicaid/Medicare..., Milliman guidelines, InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Required Licenses...
BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
and/or Milliman criteria Evaluate medical necessity, level of care, and documentation accuracy Ensure compliance with Medicare...) Experience with InterQual (must be able to pass exam) Experience with Milliman guidelines Preferred Background in Case...
. Assess medical necessity and intensity of services using the Milliman and Interqual Criteria. Conduct insurance notification...
preferred. Experience in use of Milliman/InterQual criteria. General Skills: Essential computer skills. If you're...
of Milliman/InterQual criteria. General Skills: Essential computer skills. If you’re interested, please reply...
. Additional Qualifications That Are a Plus: Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience...