and appropriateness by referencing regulatory mandates, contracts, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM...
Determination (NCD), Local Coverage Determination (LCD), MCG (Milliman Care Guidelines), NCCN, ACOG, and other nationally recognized... Required Knowledge MCG (Milliman Care Guidelines) National Coverage Determinations (NCD) Local Coverage Determinations (LCD) Medical...
, Milliman, IQVIA Short JD Highlights- Healthcare - Preferably Payer/PBM not clinical/pharma (possibly acceptable...
. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
-A and Milliman Guidelines and third party insurance requirements preferred. Experience in gathering information, monitoring...
in the medical record according to policy guidelines. Utilizes MCG- Milliman criteria to identify severity of illness...
Familiarity with CPT coding and ICD-10 terminology Knowledge of InterQual or Milliman Care Guidelines preferred Bilingual...
and their impact on the organization (for example, HEDIS, CAHPS, and NCQA) Knowledge in criteria set, including Milliman and InterQual...
with InterQual or Milliman Care Guidelines Prior RN case management or clinical coordination experience Bilingual (Spanish...