Milliman Care Guidelines jobs

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Post Discharge Case Manager
Community Health Group - 19 reviews - Chula Vista, CA 91914
Knowledge of managed care principles, CPT, ICD-10, HCPCS coding, Medi-Cal benefits and experience with inpatient and outpatient medical review guidelines...
Easily apply
Case Management Coordinator - Multiple Openings Available! /...
Aetna - 2,153 reviews - Hampton, VA
Experience and knowledge required in clinical guidelines, systems and tools i.e., Milliman, Interqual. Managed Care experience preferred....
Nurse Practitioner (NP)
TalentCare LLC - Harrisburg, PA
Awareness of UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems is helpful....

Case Management Coordinator - Multiple Openings Available! (...

Aetna - 2,153 reviews - Charlottesville, VA  +1 location
Experience and knowledge required in clinical guidelines, systems and tools i.e., Milliman, Interqual. Managed Care experience preferred....

Workers' Compensation Case Manager Level II Review

Provider Resources Inc - 3 reviews - United States  +1 location
One year or more of utilizing InterQual and/or Milliman guidelines against inpatient services experience is preferred....

Home Health Care Coordinator

naviHealth - 26 reviews - Brentwood, TN 37027
The Home Health Care Coordinator (HHCC) role is to facilitate care coordination and information with member’s home care provider(s)....

Home Health Care Coordinator

Cardinal Health - 1,769 reviews - Brentwood, TN 37027
The Home Health Care Coordinator (HHCC) role is to facilitate care coordination and information with member’s home care provider(s)....

Utilization Review Specialist

MD Anderson Cancer Center - 352 reviews - Houston, TX
$49,600 - $74,400 a year
.Perform utilization review on all patients as appropriate utilizing MCG (Formerly Milliman Care Guidelines) according to departmental guidelines....

Care Management Director

MedSearch, Inc. - 8 reviews - Kalamazoo, MI 49008 (Westnedge Hill area)
$105,000 - $120,000 a year
Knowledge of UM standards, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit...
Easily apply

Utilization Management (UM) Clinical Consultant

Aetna - 2,153 reviews - Baton Rouge, LA 70810
3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required....

Utilization Management (UM) Concurrent Review Consultant - V...

Aetna - 2,153 reviews - Charlottesville, VA
Minimum 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required....

CASE MANAGER

Premier Health Partners - 47 reviews - Franklin, OH  +2 locations
Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements preferred. INTEGRATED CARE MGT PROGRAM....

Clinical Doc Integrity Spec

The University of Vermont Medical Center - 7 reviews - Burlington, VT
$31.77 - $47.66 an hour
Maintain accurate records of review activities to comply with departmental and regulatory agency guidelines. The intended outcome of documentation improvement...
RN Complex Case Managers - Complex Medical and Case Manageme...
Healthways - 186 reviews - Baltimore, MD
Detailed knowledge and competency in all types of medical-necessity decisions, including inpatient care, sub-acute/skilled care, outpatient care, hospice care...
Easily apply
Case Management Coordinator - Multiple Openings Available! (...
Aetna - 2,153 reviews - Richmond, VA 23173
Experience and knowledge required in clinical guidelines, systems and tools i.e., Milliman, Interqual. Managed Care experience preferred....

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