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- ...levels. 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...SuggestedFull time
- ...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
$5,000 per month
...Year, Governor's Manufacturing Excellence Award, Governor's Manufacturing Advocacy Award, multiple Fortune 100 Key Supplier awards, Milliman Grand Champion Best in Employee Benefits Award, and the United States Chamber of Commerce Small Business of the Year Award....SuggestedHourly payTulsa Tube Bending
Tulsa, OK15 days ago$40.45 - $62.7 per hour
...consultations and support services within established protocols Completes Utilization Management for assigned patients. Applies Milliman Care Guidelines (Indicia) criteria to monitor appropriateness of admissions and continued stays and documents findings based on...SuggestedHourly payFull timePart timeFor contractorsWork at officeMonday to Friday$16.1 - $26.92 per hour
...experience in case management, discharge planning or management, preferred. Current BCLS (AHA) certificate preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Employment Status Full Time Shift Days Pay Transparency Saint Clare's...SuggestedDaily paidFull timeTemporary workPart timeWork experience placementLocal areaShift work- ...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
- ...Insurance companies as well as CMS to ensure that we are sending out information timely. Demonstrates awareness of nursing skills, Milliman Clinical Review criteria, NYS LOCADTR, and CMS guidelines and regulations regarding appeals for authorization, medical necessity,...SuggestedLocal areaImmediate start
- ...payment purposes, for all Inpatient or Partial services as determined in the review process. # Applies APS authorization process (Milliman standards, policies, procedures, and contractual agreements) to submitted information. Authorizes services in accordance with...SuggestedTemporary work
APS Health Care PR
Puerto Rico8 days ago - ...unrestricted registered nurse (RN) license, or eligible for licensure, in the state of Georgia, required. Certification in Case or Care Management; experience using InterQual or Milliman; Masters degree preferred. Piedmont Atlanta Hospital Piedmont Healthcare Inc.Suggested
$73.82k - $107.56k
...experience in case management, discharge planning or management, preferred. 3. Current BCLS (AHA) certificate preferred. 4. Knowledge of Milliman Criteria and InterQual Criteria preferred. St. Mary's General Hospital offers competitive compensation and a comprehensive...SuggestedDaily paidFull timeTemporary workPart timeLocal areaRelocation package- ...Hospitalización Completa o Parcial según determinado en el proceso de revisión. # Aplica el proceso de autorización de APS (estándares Milliman, políticas, procedimientos y acuerdos contractuales) a la información sometida. Autoriza servicios de acuerdo con las guías mé...Suggested
APS Health Care PR
Puerto Rico9 days ago - ...DRG LOS to other disciplines for timely discharge planning. # Provides timely clinical reviews to Third party Payers utilizing Milliman guidelines and Interqual criteria. # Coordinates the discharge appeal process accurately and timely when applicable. # Serves...SuggestedHourly payContract workLocal area
- ...experience drafting and submitting reconsiderations and appeals to payers. Preferably 2 years of experience using InterQual or Milliman criteria. Licensure/Certification/Registration: Current Texas RN license required Certified Coding Specialist (CCS), Certified...Suggested
- ...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...Suggested
- ...appropriate level of care and program compliance using InterQual Hospital Severity of Illness and Intensity of Service Criteria or Milliman Care Guidelines. Standard for initial review is within 24 hours of entry or next working day. Standard for concurrent clinical...Suggested
- ...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...Contract work
- ...customer service focus and application of positive language principles Progressive knowledge of InterQual Level of Care Criteria or Milliman Care Guidelines and knowledge of local and national coverage determinations Recent work experience in a hospital or insurance...Permanent employmentFull timeWork experience placementWork at officeLocal areaMonday to Friday
- ...have knowledge, skills and computer literacy to interpret and apply medical care criteria, such as, but not limited to, InterQual or Milliman Ambulatory Care Guidelines. Shall have a minimum of two (2) years broad-based clinical nursing experience in either an...Full timeContract workLocal areaRemote work
- ...industry, resource management, reimbursement, and evidence-based clinical practice is essential. Knowledge of InterQual and/or Milliman preferred Knowledge and Skills: Develops, maintains, and models professional, objective and value-oriented interpersonal skills...
- ...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 reimbursement...Work at officeLocal area
- ...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...Remote jobWork at office
- ...management, discharge planning or nursing management, preferred. Additional Qualifications That Are a Plus: Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer skills. Behavioral Violence...Full timeLocal areaShift work
$147.4k - $279.68k
...Senior Ccrc Consultant 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 most critical and complex issues, including retirement funding and healthcare...Full timeTemporary workWork experience placementWork at officeRemote workWorldwideFlexible hours- ...Demonstrated knowledge of payors, payor systems, cost effective utilization management, insurance terminology, InterQual criteria and Milliman guidelines, preferred. B. Personal Skills # Demonstrates ability to establish effective working relationships and...Part timeDay shift
- ...facility. Recent documented experience with InterQual, and ability to pass the InterQual exam. Recent documented experience with Milliman experience. Knowledge, Skills, Abilities, and Physical Requirements Knowledge of: Interquel or Milliman utilization review...Work at officeShift workWeekend work
- ...greater than 2 years management experience, preferred. 4. Experience in psychiatric emergency and triage preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Knowledge of psychiatric medical necessity, case management regulations in discharge...Part timeLocal areaFlexible hoursShift workAfternoon shift
$200k - $220k
...based care. Ideal candidates will bring expertise in accreditation and regulatory guidelines, particulary the Medicare 2MN rule, Milliman and Interqual guidelines, to guarantee expectations are consistently met as well as relevant and demonstrable experience in...Local areaImmediate start- ...required BLS required Commission for Case Manager Certification (CCMC) preferred Key Skills: Familiarity with MCG (Milliman Care Guidelines) preferred, including the ability to apply evidence-based criteria to support clinical decision-making, utilization...
- ...in case management, discharge planning or nursing management, preferred. 4. Current BCLS certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience and knowledge in basic to intermediate computer skills. Employment Status...Part timeWork experience placementLocal areaShift work
$112.49k - $151.38k
...Certification in Case Management, BS or BSN or related field preferred. Current BCLS certificate preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Employment Status Full Time Shift Days Pay Transparency Chino Valley...Daily paidFull timeTemporary workPart timeLocal areaShift work
