highly preferred InterQual or Milliman experience preferred. Knowledge of NCQA preferred. Requires strong oral, written...
QUALIFICATIONS: Experience in a pediatric acute hospital Familiarity with Interqual or Milliman Care Guidelines Experience...
of clinical experience as a NP or PA Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines...
. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual...
and LTAC facilities and continued stay reviews for all of these. Clinicals received are reviewed using Milliman & company...
BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
to come in with it. 5–8 years of relevant experience at a Medicare Advantage health plan or actuarial/consulting firm (Milliman, Wakely...
the patient's admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman...
for ongoing InterQual/Milliman compliance, quality improvement, and utilization review per CMS guidelines and hospital policy...