mandates, contracts, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM (American Society of Addiction...
. GENERAL DUTIES/RESPONSIBILITIES: 1. Processes second level reviews in compliance with Medicare/CMS: NCD, LCD and Milliman... classifications as well as continued stay reviews in compliance with CMS and Milliman guidelines. 3. Acts as a liaison between the...
, and federal healthcare programs Experience using Milliman or InterQual medical necessity criteria Core Competencies...
health management, and industry care guidelines such as Milliman Care Guidelines. Knowledge of configuration change...
with InterQual or Milliman Care Guidelines Prior RN case management or clinical coordination experience Bilingual (Spanish...
Preferred: 1. Knowledge of milliman and/or interqual criteria, utilization review, discharge planning and case management...
in Case Management, BS or BSN or related field preferred. Current BCLS certificate preferred. Knowledge of Milliman Criteria...
planning or management, preferred. 3. Current BCLS (AHA) certificate preferred. 4. Knowledge of Milliman Criteria...
(AHA) certificate preferred. 4. Knowledge of Milliman Criteria and InterQual Criteria preferred. Pay Transparency St...
on workflows in Benefit Point. Capable of Gathering and Analyzing ICAF, Milliman, Aggregate and DMW reports. Initiate own...