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- A leading academic medical center in Las Vegas is seeking a qualified nurse to review patient admissions for appropriateness and efficiency. Candidates must have a valid Nevada RN license, along with five years of clinical nursing experience including time in Utilization...Suggested
- ...clinical information, medical necessity determined by using evidence-based medicine, nationally recognized criteria (i.e. MCG (formally Milliman), InterQual, Centers for Medicare and Medicaid), client Protocols, and the Member’s client Coverage Documents. • Review...SuggestedFull timeRemote workRelocation package
1888MDSEARCH,Inc.
Daytona Beach, FL10 days ago $126.16k - $160.09k
...Preferred: Screen Certification, Case/Care Management certification (CCM/CMC), prior case management experience, and familiarity with Milliman/InterQual criteria . Apply Interested candidates, please submit your updated resume, interview availability, and salary...SuggestedFull timeWeekend workPride Health
White Plains, NY8 days ago- ...knowledge in basic to intermediate computer skills. Preferred qualifications: 1. Certification in Case Management, BS or BSN or related field preferred. 2. Current BCLS certificate preferred. 3. Knowledge of Milliman Criteria and InterQual Criteria preferred....Suggested
Lower Bucks Hospital
Bristol, PA13 days ago - ...Management experience, preferred Active Case Management Certification or other professional RN Certification, preferred InterQual and/or Milliman experience, preferred Superior interpersonal skills Ability to establish and maintain collaborative, effective working...Suggested
- ...prior authorization related to the Fund and benefits, as well as New York State and national guidelines. Proficient understanding of Milliman Guidelines and mandates related to Behavioral Health (BH) and prior authorization, including familiarity with the appeals process....SuggestedFlexible hours
- ...experience in an acute care setting; prior experience in case management or utilization review is strongly desired. Working knowledge of Milliman Care Guidelines (MCG) or InterQual criteria. Familiarity with Medicare, Medicaid, and private insurance regulations and...Suggested
- ...State Licensure Understands and is able to apply principals of Care Management and Person Centered Service Planning Is able to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines. Is able to understand and apply coverage guidelines and...Suggested
$72.49k - $108.74k
...processing appeals is strongly preferred. Experience researching Medicare clinical guidelines (NCD, LCD; Medicare Benefit Policy and Milliman Care Guidelines) is preferred. Experience reviewing claims and researching CPT/ICD codes is preferred. Experience with Facets,...Suggested- ...solving ability . · Ability to work within specified timeframe requirements. · Certification as a Case Manager (CCM) preferred . · Milliman’s Certification preferred. Additional Information All your information will be kept confidential according to EEO guidelines. #J-...SuggestedWork at office
$21 - $37 per hour
...the Spring of 2026 Location: This position is for an Actuarial Intern for the Life and Financial Services Practice based out of Milliman's Omaha office. Compensation: The salary range is $21 - $37 per hour, depending on relevant factors including, but not limited to...SuggestedHourly payFull timeTemporary workWork experience placementInternshipSeasonal workWork at office- ...degree — Preferred Work Experience 2 years of experience in an acute or post-acute setting — Required Experience using InterQual or Milliman — Preferred Licenses and Certifications Current unrestricted registered nurse (RN) license, or eligible for licensure, in the...SuggestedWork experience placement
$82.46k - $131.91k
Milliman’s Seattle Health Practice seeks an Administrative Manager to work under the direct supervision of the Director of Operations, supporting our leadership and broader staff team in our Seattle office. The Administrative Manager will play a pivotal role in overseeing...SuggestedFull timeTemporary workWork experience placementWork at officeRemote workWorldwideFlexible hours1 day per week- ...per Department 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 Department...Suggested
- ...payroll-related data entry, document processing, and employee reimbursement workflows (e.g., boot reimbursements).* Review weekly Milliman integration changes and ensure updates are captured accurately within Workday.* Assist with reviewing payroll input for accuracy and...SuggestedWork experience placementLocal area
$150.8k - $230.69k
...lead complex teams and manage interdisciplinary care models in a health plan or integrated delivery system. Work experience using Milliman Care Guidelines (MCG) criteria and other state-specific authorization requirements. Strategic thinker with strong operational...Temporary workWork experience placement- ...Analyzes data from various sources (medical records, claims data, Utilization Review Management (UM) criteria such as InterQual or Milliman, payor medical policies, regulatory requirements, etc.); determines causes for denials of payment and partners with management to...Work at officeLocal area
- ...communication with team, management team and interdisciplinary team Responsible for data systems imperative to the work of the department. (Milliman and Robertson, Soft med, etc) Coordinated PI activities that improve care coordination and efficient care delivery. Responsible...Full time
- ...complaints, signs and symptoms of disease to justify medical necessity for admission to acute inpatient rehabilitation facility (IRF) per Milliman Care Guidelines (MCGs). Provide critical feedback per established MCGs. Collaborate with social workers, referring case managers,...Full timeReliefLocal areaMonday to Friday
- ...clinical nursing/patient care experience with at least five years in utilization review with clinical decision tools (e.g., InterQual, Milliman) or equivalent revenue cycle clinical role; includes experience initiating and facilitating physician peer-to-peer review, medical...Work at officeLocal area
$131.6k - $249.78k
...position requires strong leadership, project management skills, and broad industry knowledge. Who We Are Independent for over 75 years, Milliman delivers market-leading services and solutions to clients worldwide. Today, we are helping companies take on some of the world’s...Full timeTemporary workWork experience placementWork at officeRemote workWorldwideFlexible hours- ...flexible and able to juggle multiple tasks simultaneously. Ability to educate peers and other clinical professionals. Knowledge of Milliman Criteria or InterQual Criteria a bonus. Other Demonstrates proactive self-starter activities and initiates opportunities for...Flexible hours
- ...RN). Current Advanced Practice Registered Nurse (APRN) Licensure. Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems is helpful. Nurse Practitioner certification in Hospice or...Local areaFlexible hours
$98.09k - $156.95k
...Integrity, FWA, or RCM functions at a health plan or payer‑focused consulting firm. Familiarity with external benchmarks (e.g., Milliman, BHI, CMS, HEDIS adjacent measures). Experience working with vendor‑based PI programs and validating vendor findings. Working knowledge...Local areaShift work- ...rotation; remain available for after-hours support as needed. Review clinical documentation for compliance with CMS Chapter 7 and Milliman Care Guidelines; provide feedback to clinicians on medical necessity, homebound status, visit utilization, and discharge planning....Remote workFlexible hoursWeekend work
- ...and peers. Critical thinking skills, Decisive judgment Ability to work with deadlines and multiple tasks. Knowledge of InterQual or Milliman admission criteria. Knowledge of Federal and State regulations. Position Summary The RN Case Manager functions as the leader of...Flexible hours
- ...fluently. Shall have knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines. Shall have a minimum of two (2) years broad-based clinical nursing experience in either an inpatient...Full timeContract workLocal areaRemote work
- ...facility. Recent documented experience with InterQual, and ability to pass the InterQual exam. Recent documented experience with Milliman experience. Knowledge of Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and...Work at officeShift workWeekend work
- ...experience in acute care or related setting Prior UM/UR experience in managed care or hospital setting Strong knowledge of InterQual or Milliman Care Guidelines Excellent documentation and communication skills Detail-oriented and able to work independently #J-18808-Ljbffr...Monday to Friday
- ...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...
