of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria). Examine and evaluate...
). Knowledge and experience with medical terminology, InterQual or Milliman criteria, TJC and Federal/State regs, relative...
. Must have proficiency with online nationally recognized UM criteria, including Milliman Care Guidelines (MCG) and/or InterQual (IQ...
degree Knowledge of Milliman Guidelines or similar clinical guidelines Knowledge of medical management policies...
) Working toward or completion of CCM/CCP/CDE certification or Advanced degree Knowledge of Milliman Guidelines or similar...
, etc. Mastery level knowledge and command of iCAF capabilities and services and Milliman capabilities and services. Developing...
degree Knowledge of Milliman Guidelines or similar clinical guidelines Knowledge of medical management policies...
review, denials and appeals InterQual and basic understanding of Milliman Care guidelines Supervisory principles...
established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual...
care setting is required. Knowledge of Inter-Qual and Milliman Care Guidelines, federal and state public health programs...