for admission, observation, and level of care to comply with federal and state mandates. Uses Milliman and Medicare...
Case Management Experience Familiarity with AllScripts Care Management Proficiency with Milliman Care Guidelines...
InterQual or Milliman/MCG criteria to validate patient status decisions and payer medical necessity compliance. Reviews medical...
guidelines, InterQual, Milliman, or similar criteria Experience in hospital or payer-facing environments Bachelor of Science...
Interqual or Milliman required High level of competency performing medical necessity reviews with accepted criteria required...
(LCSW), or Licensed Social Worker (LSW). 2. Current BCLS certificate preferred. 3. Knowledge of Milliman Criteria...
(LSW). 2. Current BCLS certificate preferred. 3. Knowledge of Milliman Criteria and InterQual Criteria preferred...
or current multi state license required. Effective Jan 2026: Current MCG (Milliman Clinical Guideline) certification...
preferred. 4. Knowledge of Milliman Criteria and InterQual Criteria preferred. #LI-CD4 Employment Status: Full Time Shift...
or management, preferred. 3. Current BCLS (AHA) certificate preferred. 4. Knowledge of Milliman Criteria and InterQual Criteria...