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They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services CMS Inpatient List). Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Milliman (MCG) Guideline and Interqual criteria experience highly preferred. Our highly specialized services meet the unique medical needs of children, from Pediatric and Neonatal Intensive Care to Children’s Emergency Services, the latest treatments for deformities of the spine including titanium rib implants and halo traction, a Heart Center, a specialized asthma program, a highly regarded Cancer and Blood Disorders Center, and growing maternal services to include consultation, delivery, and maternal fetal medicine.
ExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Demonstrate understanding necessary to assess, review and apply criteria (e.g., MCG guidelines, CMS criteria, medical policy, and health plan specific criteria.) Solid knowledge of process flow of UM including prior authorization and/or clinical appeals and grievance reviews.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Experience with national guidelines such as MCG or InterQual + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization + Advanced degree such as an MBA, MHA, or MPH + Exposure to Public Health principles, Population Health, analytics, and use of business metrics.
Work from homeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Working knowledge of MCG, InterQual, and NCQA standards. For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position.
Work from homeExpandApply NowActive JobUpdated 4 days ago
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