upon hire and maintain current;Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge...
-coordination recommendations, and clinical review summaries. Compare AI outputs against InterQual, MCG, or Milliman criteria..., or Milliman clinical review criteria. Well-versed in CMS Two-Midnight Rule, observation status, and inpatient criteria...
with prior experience at: Property & Casualty insurance carriers Insurance consulting firms (e.g., Perr & Knight, Milliman...
teams to coordinate patient care plans Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review... utilization review, case management, or managed care experience strongly preferred Familiarity with InterQual or Milliman...
required, but Bachelor’s degree preferred. Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual...
. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
– Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW – Gather Data necessary and submit to carriers...
. preferred CCM or obtained within 1year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS...
, utilization management, or regulatory reporting (e.g., HEDIS, NCQA, Milliman). 2+ years of SQL and SAS programming experience...
years of acute care nursing experience. preferred CCM or obtained within 1year Knowledge of Milliman Criteria...