assessment/Order DME Plan of care Pre-cert review Prior authorizations Utilize InterQual criteria Utilize Milliman...
for reimbursement and reason(s) for denials by auditors. Knowledge in areas such as InterQual Level of Care and Milliman & Robertson...
of Milliman criteria (MCG) preferred For UM Only: Experience must be with a Managed Care Organization or Health Plan. Pay Range...
of Milliman criteria (MCG) preferred. Pay Range: USD $85,000.00 - USD $106,300.00 /Yr....
and outpatient services, applying CMS guidelines and Milliman Care Guidelines (MCG) to support timely, accurate determinations... additional expertise. 2. Utilize CMS guidelines (LCD, NCD) to assist in determinations of referrals and utilize Milliman Care...
-cal criteria, Interqual, Milliman, or Health Plan specific guidelines Capacity to collaborate with the Medical Director...
certificate preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Employment Status Full Time Shift...
resolution skills and assertive communication skills required. Knowledge of InterQual ISD-A and Milliman Guidelines and third...
and assertive communication skills required. Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance...
clinical criteria (e.g., InterQual, Milliman) to support medical necessity determinations Communicate authorization decisions... operations strongly preferred Knowledge of InterQual or Milliman clinical criteria guidelines is a plus Strong understanding...