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- ...work with clients in all areas of the U.S., and this position will have some travel opportunities, potentially 2-5 days per year. At Milliman we strive to deliver the best products and services so that people can live for today and plan for tomorrow with confidence. We...SuggestedFull timeTemporary workWork at officeLocal areaWorldwideFlexible hours
Milliman
Omaha, NE9 hours ago $65.2k - $119.83k
...BUSINESS DEVELOPMENT MANAGER Description: Milliman is seeking a BUSINESS DEVELOPMENT MANAGER to work in a fast-growing department in Omaha. We offer a unique opportunity for the right candidate providing the best of both worlds: a flexible local office that recognizes...SuggestedRemote jobFull timeTemporary workWork experience placementCasual workWork at officeLocal areaFlexible hoursMilliman
Remote9 hours ago$78.8k - $145.13k
...POSITION SUMMARY: The HR Business Partner Team at Milliman Global Corporate Services (GCS) is looking to hire a HR Business Partner. The HR Business Partner position strengthens our company's culture by partnering with practices to develop strategies that support...SuggestedRemote jobFull timeTemporary workWork experience placementWorldwideFlexible hoursMilliman
Remote9 hours ago- ...Guidelines and Benefit Timeline. Enrollment Meetings - Conduct enrollment meetings as necessary Reporting ICAF/Milliman/DMW - Gather Data necessary and submit to carriers. Compile information for Sr. Account Consultant/Executive Team Lead as per...SuggestedFull timeContract work
Marsh Mclennan
Remote9 hours ago - ...processes. Strong background in clinical decision making, medical criteria, and discharge planning. Must be proficient with Interqual or Milliman guidelines and use. Proficient in process improvement, and performance monitoring. Required Work Experience: Minimum of three (3)...SuggestedWork experience placement
- ...Education Other Graduate of an accredited school of nursing Required Experience General Experience and knowledge of InterQual and Milliman criteria. Required General Experience and working knowledge of ICD-10 CM coding Required General Experience and Knowledge of APC coding...Suggested
- ...Duration: 4 months + RN with UM/concurrent review experience. Knowledge and experience with inpatient criteria preferably MCG (Milliman) guidelines. Must meet minimum ICM RN1 requirements including active NJ state RN license Additional Skills: Microsoft office...SuggestedLocal area
- ...readmissions across the organization. Performs and documents appropriate admission and continued stay reviews using current InterQual/Milliman Care Guidelines criteria on assigned patients. Based on the health care team's assessment, patient choice and available...SuggestedWork experience placement
- ...Reviews with hospitalist the patients admission and continued stay for medical necessity appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. Plans for discharges and care assessments. Submits necessary clinical information to the...SuggestedWork experience placementDay shift
- ...years of relevant professional experience, including managed care and quality. Being knowledgeable in using InterQual and/or MCG (Milliman) guidelines is a plus. Able to effectively communicate technical concepts and basic business concepts with team members and...SuggestedTemporary workRemote workFlexible hours
- ...Physician Advisor Licensed medical doctor. A working knowledge of InterQual and Milliman criteria are essential. Excellent clinical and administrative skills and judgment. Strong interpersonal and communication skills. Ability to effectively work with other disciplines...Suggested
- ...coordinators that work in the field) Certification as a Case Manager (CCM) preferred; required to take examination when eligible. Milliman's Certification Preferred Must be willing to obtain within 1 year from date of hire. Position requires 24 months in role before eligible...Suggested
- ...appeals. Document findings and decisions in patient management systems. Stay current with clinical guidelines (e.g., InterQual, Milliman, CMS) and healthcare regulations. Qualifications Active RN license (state-specific). Bachelor of Science in Nursing (BSN)...SuggestedWork at officeRemote work
Commence
Annapolis Junction, MD12 days ago - ...guidelines and regulations. Utilize clinical decision-making skills, medical criteria, and discharge planning tools like Interqual or Milliman guidelines. Implement process improvements and monitor performance metrics. Communicate effectively in stressful environments and...Suggested
- ...making prior to Medical Director/Physician Advisor referral. Applies submitted information to KFHP authorization process (utilizing Milliman, USA, Interqual medical guidelines, Process Standards, Policies and Procedures, and Standard Operating Procedures). Authorizes...Suggested
$70k - $85k
...analytics and reporting; synthesizes payer claims and reimbursement data; and applies external benchmarks (e.g., Medicare fee schedules, Milliman data, HEDIS). The role develops and delivers reports and analyses using tools such as Excel and Tableau for finance leadership,...Contract work- ...regulatory agencies Peer Review Organization (PRO), Joint Commission, and multiple payer defined criteria for eligibility. Applies Milliman Careguidelines Criteria for appropriate status determination. Engages in discussion with the attending physician for...Full timeFor contractorsWork at officeLocal areaFlexible hoursShift workDay shift
- ...patient admissions, and continued stays, based on the clinical documentation in the Electronic Health Record (EHR) in accordance with Milliman Care Guidelines (MCG). The Case Manager assists in coordination of care among multidisciplinary team members such as Medical...Hourly payContract workLocal area
$67.6k - $136.16k
Description Milliman's Tampa Health practice is seeking an Actuarial Analyst who will perform data analysis and actuarial projections using Excel, SQL, SAS, Python or other tools while working with proprietary Milliman programs to assist with consulting for various health...Full timeTemporary workWork experience placementWork at officeRemote workWorldwideFlexible hours- ...responsibilities as assigned. Qualifications and Skills Knowledge of Utilization Review criteria to include Interqual and/or Milliman preferred. Knowledge in Medicaid, Medicare, Managed Care review and documentation requirements. Is knowledgeable of state and...
- ...skills. Preferred Qualifications: Five years of acute care nursing experience. CCM or obtained within 1 year Knowledge of Milliman Criteria and InterQual Criteria preferred. Current BCLS certificate, preferred Employment Status Full Time Shift...Full timeWork experience placementLocal areaShift work
$32.6 - $42.79 per hour
...based care management ~1+ years of experience in Care Coordination and Navigation Bonus points: BSN Working knowledge of Milliman Guidelines CCM Certification Behavioral Health experience At Oscar, being an Equal Opportunity Employer means more than...Hourly payFull timeRemote workHome office- ...ensure efficient resource utilization and quality patient outcomes. Responsibilities Review admissions using InterQual and/or Milliman criteria Evaluate medical necessity, level of care, and documentation accuracy Ensure compliance with Medicare, Medicaid,...
- ..., and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. Apply Milliman Care Guidelines and payer-specific criteria to determine appropriate patient status. Collaborate with attending physicians to clarify...Full timeWork at officeLocal areaMonday to FridayShift work
$46.76 - $51.76 per hour
...Responsibilities Determines medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM, Medicare Guidelines, Federal Employee Program and Policy Guidelines, Medical Policy, and...Work at office- ...people skills PREFERRED QUALIFICATIONS: Prior experience in a clinical setting (e.g. hospital, doctor’s office, outpatient facility) Familiarity with clinical standards (e.g. Milliman Care Guidelines, InterQual Criteria) #J-18808-Ljbffr Healthcare Legal Solutions LLCWork at office
$51 per hour
...appropriateness determinations and support prior authorizations. Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines). Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines....Contract workWork at officeLocal areaRemote workFlexible hours- ...regulatory, and payer issues preferred Knowledge of state, local, and federal programs strongly preferred Experience in use of Milliman/InterQual criteria Computer skills essential Core Competencies Demonstrates ability to establish two-way communication by...Full timeLocal areaWeekend work
- ...insurance carriers, and brokers Maintain accurate and timely documentation in internal systems and CRM platforms Contribute to Milliman's service model by delivering a consistent, high quality customer experience Use customer interactions and feedback to support...Hourly payFull timeTemporary workWork experience placementCasual workSeasonal workWork at officeWorldwide
- ...meetings as necessary. Develop stewardship report based on workflows in Benefit Point. Capable of Gathering and Analyzing ICAF, Milliman, Aggregate and DMW reports. Initiate own correspondence with clients. Ensure that these items are delivered or mailed to...Contract workWork at officeWeekend work
