of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
, discharge planning or management, preferred. Current BCLS (AHA) certificate preferred. Knowledge of Milliman Criteria...
of interQual IS-SI, Milliman nd Robertson Managed Care Guidelines, Erickson Life Skills (Age Competencies}, Medicare Part...
setting required. Minimum of 2+ years utilization review or claims auditing experience required. Experience with Milliman...
or management, preferred. Current BCLS (AHA) certificate preferred. Knowledge of Milliman Criteria and InterQual Criteria...
) and/or Health Care Quality (CPHQ) Master’s degree in Nursing or MBA Interqual Certified Instructor (ICQI) or Milliman training...
using electronic medical records or acute hospital utilization review using InterQual or Milliman. Working knowledge...
setting required. Minimum of 2+ years utilization review or claims auditing experience required. Experience with Milliman...
planning or nursing management, preferred. 4. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria...
. 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...