to come in with it. 5–8 years of relevant experience at a Medicare Advantage health plan or actuarial/consulting firm (Milliman, Wakely...
the patient's admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman...
for ongoing InterQual/Milliman compliance, quality improvement, and utilization review per CMS guidelines and hospital policy...
’ clinical presentation against Milliman Care Guidelines (MCG) to identify admission status, working DRG and target...
on preventing and appealing denials and educates on medical necessity criteria such as InterQual and/or Milliman Care Guidelines...
for ongoing InterQual/Milliman compliance, quality improvement, and utilization review per CMS guidelines and hospital policy...
nursing experience. preferred 5. CCM or obtained within 1year 6. Knowledge of Milliman Criteria and InterQual Criteria...
preferred. Experience in Milliman and Interqual preferred. Leadership experience, knowledge of legal aspects of coding... experience preferred. Experience using healthcare web based applications, Milliman, Interqual, etc. , preferred. * Basic...
preferred. Experience using healthcare web based applications, Milliman, Interqual, etc. , preferred. * Basic computer...
-based criteria such as InterQual or Milliman Care Guidelines (MCG) to evaluate admissions, continued stays, and discharge...