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Knowledge of: Acute Care Criteria, Care Coordination, DC Planning, Inter Qual/Milliman criteria, precertification, Utilization Review, insurance, managed care and community resources preferred.
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Knowledge of medical terminology, healthcare finances, alternative care options, utilization management, health plan criteria, established criteria such as MCG formerly known as Milliman Care Guidelines and its applications required.
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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.
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Knowledge and experience with Milliman Care Guidelines. The role will function as a liaison (onsite at a health system in Anne Arundel County and occasional weekend work may be required) with the hospital care team including case managers, social workers, and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge.
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Apply standard utilization (InterQual and/or Milliman) criteria for clinical reviews to determine medical necessity including intensity of service, severity of illness and discharge screens. Office environment May visit hospital locations and vendors The noise level in the work environment is usually low TRAVEL Work will primarily be done at or near Baylor All Saints Medical Center in Fort Worth (76104) Future travel to Irving and Grapevine locations may also be required Some travel including overnight stays may be required.
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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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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.
$70,000 - $122,000 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Current Standards of Care & Criteria, working knowledge of Intequal and/or Milliman. Certification as Certified Case Manager (CCM), or Accredited Case Manager (ACM). MSW and three (3) years previous experience as a hospital care coordinator OR a BSW and five (5) years previous experience as a hospital care coordinator.
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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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Applicants must be willing to travel to the Milliman office in Brookfield, WI and travel to client sites, industry conferences, etc. Milliman IntelliScript is a group of a few hundred experts in fields ranging from actuarial science to information technology to clinical practice.
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Support Account Executives to work closely, and communicate consistently, with Milliman Strategic Advisors in direct support of One Milliman effortsPartner with, and assist, account executives and client services staff.
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Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and MedicaidMedicare contracts and benefit systems At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
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Knowledge of Interqual or Milliman guidelines (MCG) Knowledge of Interqual or Milliman guidelines (MCG) We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life.
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Knowledge of Inter-Qual and Milliman Care Guidelines, federal and state public health programs, and long term care/skilled nursing environments. Knowledge of Inter-Qual and Milliman Care Guidelines, federal and state public health programs, and long term care/skilled nursing environments.
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Knowledge of Milliman Criteria and InterQual Criteria preferred. Behavioral Violence Prevention Training within 3 months of hires and maintain current. Knowledge of Milliman Criteria and InterQual Criteria preferred.
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