...rationales supported by clinical criteria, including but not limited to, CMS, Florida Medicaid, CFR, Health Plan, InterQual (IQ), Milliman Care Guidelines (MCG), and UpToDate.
4. Complies with company and department policies and procedures to ensure timely and denials....
Suggested
Work experience placement
...discharge planning or nursing management, preferred.
4. Current BCLS (AHA) certificate upon hire and maintain current;
5. Knowledge of Milliman Criteria and InterQual Criteria preferred.
6. Experience and knowledge in basic to intermediate computer skills.
7. Behavioral...
Suggested
Full time
Work experience placement
...disease to justify Medical Necessity for acute care treatment.
Ensure that patients are in the appropriate level of care based on Milliman Care Guidelines (MCG).
Conduct brief clinical assessment within 48 hours of admission or as patient acuity allows.
Complete...
Suggested
Full time
Local area
Monday to Friday
...Description
Milliman's Seattle Health Practice is looking for an Associate Actuary with experience in health actuarial work. The position requires creative actuarial capabilities, good communication and interpersonal skills, and organizational talents. A high degree...
Suggested
Holiday work
Full time
Temporary work
For contractors
Work experience placement
Remote job
Worldwide
Flexible hours
...continued stay reviews and potential discharge date. Utilizes other application tools to document including Veracity, Optum, InterQual, Milliman, etc.
* Facilitates peer to peer reviews with payer/providers.
* Actively participates in clinical case review/rounds with the...
Suggested
Part time
Shift work
Weekend work
...experience in case management, discharge planning or management, preferred.
3. Current BCLS certificate preferred.
4. Knowledge of Milliman Criteria and InterQual Criteria preferred.
# LI-BY1
#gadsdenalabama #birminghamalabama #montgomeryalabama #tuscaloosaalabama...
Suggested
Relief
Immediate start
Shift work
...Management experience.
Case load/number of patients per day/consults per day 15-20
Do you require InterQual criteria or Milliman experience: No, but need to have general understanding of discharge readiness
Discharge planning for complex patient populations...
Suggested
Weekly pay
Holiday work
Permanent employment
Full time
Contract work
Shift work
...POSITION SUMMARY:
Milliman, Global Corporate Services (GCS) is seeking an experienced Manager, Application Development to lead our team of developers in building and maintaining cloud-based applications, including those built on M365 technologies. The ideal candidate...
Suggested
Holiday work
Full time
Temporary work
For contractors
Work experience placement
Remote job
Worldwide
Flexible hours
...Who We Are -
The Milliman - Tampa Supplemental Products Team is a practice within Milliman, Inc., one of the largest actuarial consulting firms in the world. Our team was established in 1998 and has since expanded into a broad consulting group which focuses on supplemental...
Suggested
Holiday work
Full time
Temporary work
For contractors
Flexible hours
...minimum of 2 years Utilization Management/Review in an acute care setting, Minimum of 2 yeras experience working with InterQual or Milliman in an acute care setting, and Bilingual preferred.
Experience:
Experience with Admin/Finance for patient stays
Medicare...
Suggested
For contractors
Flexible hours
...goals
Identify new opportunities to increase utilization
Identify patients who require IP level of care in accordance with Milliman or InterQual criteria
Develop Clinical Recommendations
Review and assess the eligibility of patients in preparation for hospital...
Suggested
Holiday work
Temporary work
Remote job
Flexible hours
...but not limited to, education, relevant work experience, qualifications, skills, certifications, location, etc.
BENEFITS:
At Milliman, we focus on creating an environment that recognizes - and meets - the personal and professional needs of the individual and their...
Suggested
Holiday work
Full time
Temporary work
For contractors
Work experience placement
Remote job
Worldwide
Flexible hours
...software solutions. The focus will be on architecting and implementing complex software solutions into applications and services used by Milliman's employee benefit administration teams to service their clients as well as the ongoing support of production defects.
Who We...
Suggested
Holiday work
Full time
Temporary work
For contractors
Work experience placement
Remote job
Worldwide
Flexible hours
...and Rewards.
Experience
* Minimum 2 years of utilization / care management experience applying evidence-based criteria (i.e.: Milliman, Interqual); CMS; Health plan medical policy / clinical coverage guidelines required
* Experience performing medical management...
Suggested
Contract work
Work experience placement
Remote job
Shift work
...SPONSORSHIP IS NOT AVAILABLE FOR THIS OPPORTUNITY
Who We Are
Milliman FRM LLC is seeking an ETF Portfolio Analyst to join its Portfolio Management Group in Chicago. Currently the group manages 80 ETFs with AUM totaling approximately $6 billion across multiple strategies...
Suggested
Holiday work
Full time
Temporary work
For contractors
Flexible hours
Night shift
...Preferred Qualifications:
~2+ years of clinical experience
~ Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems
Physical Demands:
The physical demands described here...
Work experience placement
Relocation bonus
...POSITION SUMMARY:
The Governance/Corporate Paralegal works with the Assistant Corporate Secretary and the Governance team of Milliman's Legal Department primarily related to corporate governance of Milliman's entity portfolio. Tasks will have direct visibility to C...
Holiday work
Full time
Temporary work
For contractors
Work experience placement
Local area
Worldwide
Flexible hours
...Strong written and verbal communication skills
Preferred:
+ Bachelor of Science in Nursing
+ CCM certification
+ Knowledge of Milliman or InterQual criteria
+ Experience providing care in the home setting
+ Experience working within a managed care environment...
...such as HEDIS metrics. The Senior Data Analyst should be familiar with external benchmark sources (i.e., Medicare fee schedules, Milliman data, HEDIS, etc.) and facile in extracting publicly available data. This individual will develop and present reports, including excel...
Contract work
Local area
...Management experience.
Case load/number of patients per day/consults per day 15-20
Do you require InterQual criteria or Milliman experience: No, but need to have general understanding of discharge readiness
Discharge planning for complex patient populations...
Holiday work
Permanent employment
Full time
Contract work
Shift work
...discharge planning or nursing management, preferred. Current BCLS (AHA) certificate upon hire and maintain current;. Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer skills. Behavioral Violence...
Work experience placement
Milliman's Seattle Health Practice is looking for actuarial analysts to work with consulting actuaries in the development and use actuarial models for various purposes, including pricing and forecasting. This position provides excellent opportunities for professional growth...
Holiday work
Full time
Temporary work
For contractors
Work experience placement
Internship
Worldwide
Flexible hours
...What We Do
Milliman IntelliScript is a group of a few hundred experts in fields ranging from actuarial science to information technology to clinical practice. Together, we develop and deploy category-defining, data- driven, software-as-a-service (SaaS) products for...
Remote job
Holiday work
Full time
Temporary work
For contractors
Flexible hours
...-Broad knowledge of health care delivery/managed care regulations and experience with evidence based care guidelines (i.e. MCG/Milliman, Interqual).
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We...
Remote job
Weekend work
Afternoon shift
...validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
Examine and evaluate patient records to verify the...
Remote job
Shift work
Weekend work
...but not limited to, education, relevant work experience, qualifications, skills, certifications, location, etc.
Benefits
At Milliman, we focus on creating an environment that recognizes - and meets - the personal and professional needs of the individual and their...
Holiday work
Full time
Temporary work
For contractors
Work experience placement
Remote job
Flexible hours
...for clinical denials and appeal inquiries. The Clinical Appeals Nurse will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG), InterQual, and/or other relevant guidelines, determined the viability of the appeal, and manage the appeal...
Permanent employment
For contractors
Relief
...regulatory, and payer issues preferred
~ Knowledge of state, local, and federal programs strongly preferred
~ Experience in use of Milliman/InterQual criteria
~ Registered Nurse (RN) NYS license required
~ PRI/Screen certification strongly preferred.
~ C.C.M. (...
Local area
...members on disease processes
* Encouraging members to make healthy lifestyle changes
* Documenting and tracking findings
* Utilizing Milliman criteria to determine if patients are in the correct hospital setting
* Making welcome home calls to ensure that discharged member...
Work experience placement
Remote job
Do you have the analytic skills to find insight in a pile of healthcare data? Do you thrive in a fast-paced environment? Milliman's NYC-Atlanta Health Practice is seeking professionals from a variety of analytic and strategic backgrounds to join our vibrant staff, consulting...
Remote job
Holiday work
Full time
Temporary work
For contractors
Work experience placement
Interim role
Flexible hours