. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
. Knowledge of Milliman (MCG) criteria. PRI/screen certification. PHYSICAL WORKING CONDITIONS Sitting in a comfortable position... to assess clinical and discharge needs of orthopedic surgical patients. Knowledge of Milliman (MCG) criteria. PRI/screen...
, utilization management, or regulatory reporting (e.g., HEDIS, NCQA, Milliman). 2+ years of SQL and SAS programming experience...
about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems...
each case identified/referred for appeal based on Milliman Care Guidelines (MCG) or InterQual guidelines, determine the...
required. Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer...
of acute care nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual...
and/or Milliman Care Guidelines 2. Demonstrated knowledge of federal and state laws, NCQA and industry regulations related...