Milliman Care Guidelines jobs

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Executive Director of Population Health/Case Management
Ability to operationalize the requirements of Milliman and Interqual care guidelines within the department. Transitional care program....
VP, Health Services
Magellan Health - 487 reviews - Brooklyn, NY 11201
Experience applying medical management treatment guidelines, such as InterQual / McKesson, Milliman, or other practical management guidelines required....
Care Manager
Uses Milliman to determine appropriate level of care (skilled, rehab, etc.). Identifies the estimated discharge date upon admission and documents on whiteboards...

Clinical Appeals Nurse, Remote

Managed Resources - 4 reviews - Remote
Interqual and Milliman Care Guidelines (MCG):. Experience and success in appealing managed care denials and underpayment decisions....
Easily apply


Cook County Health & Hospitals System - 59 reviews - Chicago, IL
$31.58 an hour
Uses all available information sources to support care coordination activities-this may include portals, electronic medical records, claims data, plan...

Medical Review Nurse (MRN)

Provider Resources Inc - 23 reviews - United States
$69,000 - $87,000 a year (Indeed est.)
One year or more of utilizing InterQual and/or Milliman guidelines is preferred. Utilize Internet and Intranet resources for applicable research, e.g., evidence...

Clinical Care Reviewer Utilization Management

AmeriHealth Caritas - 311 reviews - Harrisburg, PA
Applies AHC authorization process (InterQual Medical Guidelines, Milliman USA, process standards, policies and procedures, and standard operating procedures) to...

Utilization Review Nurse - Remote Part Time

Change Healthcare - 347 reviews - Pensacola, FL
$50,000 - $64,000 a year (Indeed est.)
Analyze, investigate and resolve individual care quality, coordination of care, service and access issues. Accountability for processing referral/authorization...

Clinical Doc Integrity Spec-PD

The University of Vermont Medical Center - 67 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...


SUNY Downstate Medical Center - 119 reviews - Brooklyn, NY
$61,621 - $125,854 a year
Utilize standard screening criteria-Milliman Care Guidelines CareWEbQI-to justify level of care, medical necessity, severity of illness and intensity of care....

Nurse Referral Specialist (Grand Clinic)

Lake County IL - 6 reviews - Waukegan, IL
InterQual or Milliman Knowledge / experience. The Referral Specialist Nurse (RS-RN) is responsible for reviewing proposed outpatient specialty care referrals...

Clinical Denials Nurse, CCS

Managed Resources - 4 reviews - Remote
Working knowledge of InterQual and Milliman Care Guidelines as well as payer specific medical guidelines and how to apply them in an appeal....
Easily apply

Utilization Review Specialist - Physician Advisory Services

R1 RCM - 276 reviews - Remote
The Utilization Review Specialist will determine the appropriate cases for review, utilizing client specific guidelines....
Utilization Review/Denial Specialist RN
He/she ensures level of care charges are applied accurately and meet compliance within CMS and commercial insurance guidelines....
Sr. Licensed Behavioral Health Care Advocate
Knowledge of Level of Care Guidelines (i.e., Milliman, Interqual, etc.). Case manager, care advocate, social worker, therapist, counselor, mental health,...