and/or Milliman Guidelines Care Coordination Discharge Planning Collaboration Denial Prevention and Management Regulatory...
and/or Milliman Guidelines Care Coordination Discharge Planning Collaboration Denial Prevention and Management Regulatory...
with Milliman (MCG) or InterQual guidelines Experience researching and preparing clinical information for case review...
, conflict resolution skills and assertive communication skills required. Knowledge of InterQual ISD-A and Milliman Guidelines...
criteria such as InterQual and Milliman Care Guidelines. Perform retrospective medical record reviews to validate... with InterQual and/or Milliman Care Guidelines, and electronic medical record systems. Experience with inpatient level‑of‑care...
biannual MCG-IRR testing (Milliman Care Guidelines-Inter Rator Reliability) that is administered to clinical and medical...
, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, Medicaid/Medicare... requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Pref...
) Working toward or completion of CCM/CCP/CDE certification or Advanced degree Knowledge of Milliman Guidelines or similar...
of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
exam. Recent documented experience with Milliman experience....