based on evidence-based clinical guidelines, i.e. Milliman Clinical Guidelines (MCG) and InterQual Criteria. Ensures... to this role: Knowledge of medical terminology. Working knowledge of InterQual, Milliman Care Guidelines, and Coding Rules...
, government payer and/or denial rules Required InterQual and/or Milliman (MCG) experience Required Licenses and Certifications...
management, preferred. 4. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria...
BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status...
, actuarial systems (e.g., PeopleSoft GL, Triton, Milliman ALFA) data architecture, data integrations and cloud platforms Proven...
management skills. Minimum of two years of experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation...
within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status...
-Current Version (CPT) coding;and McKesson (InterQual) and/or Milliman Care Guidelines. Life Support Certifications...