. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
Milliman’s MG-ALFA/Integrate and Moody’s GGY AXIS. Strong development environment with support for continued technical... experience with a strong foundation in life insurance. Proven hands-on actuarial modeling experience, ideally in Milliman’s MG...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
management processes and operating procedures including;Milliman guidelines, Observation process, medical management principles...
Experience 2 years of experience in an acute or post-acute setting Required Experience using InterQual or Milliman Preferred...
upon hire and maintain current;Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge...
-coordination recommendations, and clinical review summaries. Compare AI outputs against InterQual, MCG, or Milliman criteria..., or Milliman clinical review criteria. Well-versed in CMS Two-Midnight Rule, observation status, and inpatient criteria...
teams to coordinate patient care plans Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review... utilization review, case management, or managed care experience strongly preferred Familiarity with InterQual or Milliman...
with prior experience at: Property & Casualty insurance carriers Insurance consulting firms (e.g., Perr & Knight, Milliman...
required, but Bachelor’s degree preferred. Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual...