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- ...~ EMR: EPIC ~ Referrals: naviHealth ~(Planning to transition fully to EPIC Care Management within a year) ~ InterQual/Milliman: Not required ~ Must understand general discharge readiness &##129489;&##129309;&##129489; Team Structure Current CM...SuggestedFull timePart timeRemote workMonday to FridayShift workWeekend work
Talent4Health
Jackson, MS3 days ago $180k - $250k
...Job Description Medical Physicist Olean General Hospital Olean, NY Mildred Milliman Radiation Medicine Center Olean General Hospital’s Mildred Millman Radiation Medicine Center has an opening for a qualified Medical Physicist. This is hybrid...SuggestedMonday to FridayKaleida Health
Olean, NY20 days ago$140k - $214k
...management practices, ensuring alignment with hospital goals and industry standards. Maintain working knowledge of InterQual and Milliman & Robertson criteria. Collaborate with interdisciplinary teams to address patient needs effectively. Manage hospital...SuggestedPermanent employmentFull timeRelocation packageAmaya Staffing Consultants LLC
Anaheim, CA13 days ago$39.28 - $45.94 per hour
...Bonus points: CCM Certification Bilingual in Spanish and/or creole reading, writing, speaking BSN Working knowledge of Milliman Guidelines This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment...SuggestedHourly payFull timeRemote workHome officeOscar Health
Dallas, TX4 days ago- ...RESPONSIBILITIES Assesses and evaluates the patients plan of care within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status that coincides with 2MN rule and medical necessity of hospital admission....SuggestedFull timeWork experience placementBank staffImmediate start
Parrish Medical Center
Titusville, FL7 days ago - ...utilization and data. RESPONSIBILITIES & DUTIES: Determines compliance of pre-established medical necessity criteria applying Milliman, and Healthcare Management Guidelines. Redirects members for alternative treatment/service that are appropriate to the members...SuggestedWork at officeFlexible hours
Advanced Medical Management
Long Beach, CA9 days ago $31 - $45 per hour
...and procedures ~95 - 100% compliance with Utilization Management health plan delegation standards for Case Management ~ Utilize Milliman Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge...SuggestedHourly payWork from homeHome officeAstrana Health, Inc.
Monterey Park, CA5 days ago- ...TRICARE purchased care system, Medicare, Medicaid and the Veterans Administration (VA) is desired. Experience with McKesson (InterQual) and/or Milliman Care Guidelines desired. Working conditions include prolonged walking, standing, sitting or bending, and computer use...SuggestedContract workTemporary workLocal area
Posterity Group LLC
Fairchild Air Force Base, WA4 days ago $70k
...Compassionate with teamwork skills Knowledge of terminology CPT codes and ICD 10 Bilingual preferred Knowledge of InterQual or Milliman Care Guidelines preferred Minimum Qualifications: Active FL RN license, minimum 3 years of RN Clinical Coordinator experience....SuggestedFull timeApprenticeshipWork experience placementWork at officeLocal areaRelocationMonday to FridayFlexible hoursDay shiftPalm Medical Centers
Spring Hill, FL22 days ago$100k - $130k
...analytics) Familiarity with healthcare risk adjustment models such as HCC and CDPS Familiarity with claims groupers such as Milliman’s HCG Product management training or analytics product delivery experience Physical Requirements Repetitive motions that...SuggestedRemote jobPermanent employmentFull timeTemporary workH1b- ...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...SuggestedFull timeWork experience placementMonday to Friday
- ...identified. • Apply pre-approved criteria and guidelines to validate medical necessity/appropriateness of treatment (e.g., ODG, MTUS, Milliman Care Guidelines, InterQual • Maintain appropriate discretion with regard to confidential or sensitive information. Refrain from...SuggestedRemote jobWork at officeLocal areaImmediate start
Nexus
Schertz, TX28 days ago - ...Competence in age-specific care for neonatal, pediatric, adolescent, adult, and geriatric patients. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding benefits - including medical, dental, and vision...Suggested
$71.7k
...ranked #1 for Payer Quality Analytics by clients for the last three years in the Best in KLAS report. MedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk...SuggestedFull timeTemporary workWork experience placementRemote workFlexible hoursMilliman
Appleton, WI19 hours ago- ...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
$49.9k - $88.9k
...and including responsibility of providing all aspects of plan administration to assigned clients. 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- ...organizations have come to rely on MedInsight analytic solutions for healthcare cost and care management. MedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk...
$65.2k - $161.58k
...Individual(s) must be legally authorized to work in the United States without the need for immigration support or sponsorship from Milliman now or in the future. Milliman'sCMH Health Practice islooking for a Power BI Analyst with a strong data visualization background...Full timeTemporary workWork experience placementWork at officeRemote workWorldwideFlexible hours- ...Account Manager Milliman is seeking an Account Manager to work in a fast-growing department in Omaha to both nurture existing client relationships and drive new business growth. This role requires a proactive professional who excels at understanding client needs, delivering...Full timeTemporary workWork experience placementCasual workWork at officeLocal areaFlexible hours
$50k - $81k
...organizations have come to rely on MedInsight analytic solutions for healthcare cost and care management. MedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk...Full timeWork experience placementWork at office$90.62k - $145.13k
...Quantitative Developer The Quantitative Development group, within Milliman's Financial Risk Management Practice ("FRM"), focuses on capital markets modeling, market-consistent valuation of assets and liabilities, quantitative risk analytics, and simulation analysis...Full timeTemporary workWork experience placementInternshipWork at officeFlexible hours- ...criteria/guidelines and plan language to validate medical necessity/appropriateness of treatment (e.g. Policy Plan Language, Milliman Care Guidelines, InterQual) •Ability to understand and analyze plan language documentation •Proper citation of evidence-based literature...Remote jobWork at officeLocal areaImmediate start
ProPeer
Schertz, TX6 days ago - ...experience in an inpatient hospital (bedside care) setting. Required experience in Utilization Management and/or familiarity with Milliman Care Guidelines. Required experience in acute inpatient (hospital) nursing, demonstrating strong clinical knowledge and...
- ...with client onboarding and provide backend support to sales, including presentation preparation and benchmarking research (e.g., Milliman). What You'll Bring ~5+ years of administrative or operations experience, ideally in professional services or insurance. ~...Full timeWork at office
$78.8k - $145.13k
...organizations have come to rely on MedInsight analytic solutions for healthcare cost and care management. MedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk...Full timeTemporary workWork experience placementWork at officeRemote workFlexible hours- ...healthcare setting with a minimum of 7 years using electronic medical records or acute hospital utilization review using InterQual or Milliman. Working knowledge of medical coding, case management, government and contracted payers. MINIMUM LICENSURE/CERTIFICATION...Full time
- ...competing priorities. Requires knowledge of Microsoft Office Excel, Word, PowerPoint, and Outlook. Preferred Experience: Milliman software EPIC software Length of Stay Reporting Kronos timekeeping software Crystal Reports software Location: Portland...Work at officeFlexible hours
- ...organizations have come to rely on MedInsight analytic solutions for healthcare cost and care management. MedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk...Contract work
- ...audits of active cases to identify documentation and order issues in real time, preventing downstream denials. Applies InterQual or Milliman/MCG criteria to validate patient status decisions and payer medical necessity compliance. Reviews medical records to validate...Work experience placement
- ...Working knowledge of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare and Medicaid rules, regulations, coverage guidelines, NCDs and LCDs. Working knowledge of Medicare, Medicaid and Managed...ReliefWork at office
