) and/or Health Care Quality (CPHQ) Master’s degree in Nursing or MBA Interqual Certified Instructor (ICQI) or Milliman training...
setting required. Minimum of 2+ years utilization review or claims auditing experience required. Experience with Milliman...
regulations as well as coverage guidelines and benefit limitations. The ability to apply Interqual/ Milliman Care Guidelines...
planning or nursing management, preferred. 4. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria...
. GENERAL DUTIES/RESPONSIBILITIES: 1. Processes second level reviews in compliance with Medicare/CMS: NCD, LCD and Milliman... classifications as well as continued stay reviews in compliance with CMS and Milliman guidelines. 3. Acts as a liaison between the...
such as Milliman's HCG Product management training or analytics product delivery experience Physical Requirements Repetitive...
applying medical management treatment guidelines, such as InterQual / McKesson, Milliman, or other practical management...
programs strongly preferred Experience in use of Milliman/InterQual criteria A Care Management certification preferred...
of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare...
. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...