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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 process.
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Family building benefits, including adoption and fertility assistance and paid parental leave up to 12 weeks for employees who have worked for Milliman for at least 12 months and have worked at least 1,250 hours in the preceding 12-month period.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual, Milliman Ambulatory Care Guidelines, Specialty Referral Guidelines (SRGs) or other evidence-base guidelines identified by the MHS.
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Milliman FRM LLC is seeking an ETF Portfolio Analyst to join its Portfolio Management Group in Chicago. Milliman covers 100% of the premiums for life insurance, AD&D, and both short-term and long-term disability coverage.
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Must have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Current Version (ICD), and Current Procedural Terminology-Current Version (CPT) coding; and McKesson (InterQual) and/or Milliman Care Guidelines.
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Demonstrates proficiency in utilizing CHCS, AHLTA, ESSENTRIS, CCS/CareRadius (RMS), MCSC Contractor’s portal, MHS GENESIS, and AVAYA systems. Enters data in CHCS, AHLTA, MHS GENESIS, Referral database, and other office automation softwareprograms as appropriate.
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The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines will be vital to this role. Job DescriptionJob DescriptionRN- Utilization Review Nurse LTSSFull Time 100% Remote OpportunityCOME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE.
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The RN Clinical Appeals Nurse will actively manage, maintain and communicate denial/appeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials. The Clinical Appeals Nurse is responsible for appealing all inappropriate denials through all possible levels of the appeal process.
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Capable of Gathering and Analyzing ICAF, Milliman, Aggregate and DMW reports. Compliance oversight for “Schedule A” request from carriers, Form 5500, Medicare Part D Disclosures and CMS Reporting, HIPAA and ERISA and COBRA.
Full-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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MAJOR DUTIES & RESPONSIBILITIESConduct assessments of medical services to 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.
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The Senior Data Analyst should be familiar with external benchmark sources (i.e., Medicare fee schedules, Milliman data, HEDIS, etc.) Use external benchmark sources (i.e., Medicare fee schedules, Milliman data, HEDIS, etc.
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Milliman MCG experience preferred. Become a part of our caring community and help us put health first. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
RemoteExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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MedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk management and regulatory compliance, data analytics and business transformation as well as a range of other consulting and technology solutions.
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The Milliman MedInsight group has been rapidly growing within different segments of the healthcare field, with presence amongst payers, employers, providers, accountable care organizations, pharmacy benefit managers, digital health companies, and other types of organizations.
Full-timeExpandUpdated 25 days ago - UpvoteDownvoteShare Job
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Be comfortable presenting and discussing ideas with senior leaders of client organizations and Milliman MedInsight. Experience working with relational and big data database technologies (Databricks, Microsoft Azure.
$85,000 - $194,000 a yearFull-timeExpandUpdated 29 days ago
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