compliance with applicable criteria, medical policy, member eligibility, benefits and vendor contracts. Apply Milliman Care... in Case Management a plus Proficient in application and use of industry standard Utilization Management criteria (Milliman...
standards (InterQual and Milliman). Conduct admission, concurrent, and length-of-stay reviews and communicate with payors...
, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. Collaborates with clinical teams...
in a managed care outpatient or community environment, preferred. Recent working knowledge of Milliman Care Guidelines, preferred...
-A and Milliman Guidelines and third party insurance requirements preferred. Experience in gathering information, monitoring...
in a managed care outpatient or community environment, preferred. Recent working knowledge of Milliman Care Guidelines, preferred...
of Milliman Care Guidelines (MCG) or InterQual criteria. Familiarity with Medicare, Medicaid, and private insurance regulations...
Work Experience 2 years of experience in an acute or post-acute setting Required Experience using InterQual or Milliman...
., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria). Examine and evaluate patient...