…, and prefer at least 3 years' experience with supporting utilization management reviews, managed care programs or care delivery networks Expertise in the

…of care , and federal and state regulations including Medicare, Medicaid, and Managed Care reimbursement rules A measurable track record of survey success in

…years' experience within a hospital or clinical environment, an insurance company, managed care organization, other financial service setting, registration,

…up to date knowledge of payer guidelines including Medicare, Medicaid, Commercial Insurance, Managed Care Plans, etc. Confirm that the defined level of

…(AMA), the Centers for Medicare & Medicaid Services (CMS) Contractor Medical Directors, managed care companies, and other sources. The individual will also lead

…and Social Work in the acute care setting and with insurance payers, managed care and government healthcare plans. Working knowledge of UM review processes,

…practice settings and healthcare delivery systems 15. Thorough and solid knowledge of health care and managed care delivery systems. This includes standards

…monitoring tools- InterQual, Milliman Care Guidelines (MCG), principles of Managed Care , Computer applications, including but not limited to: Windows,

…monitoring tools- InterQual, Milliman Care Guidelines (MCG), principles of Managed Care , Computer applications, including but not limited to: Windows,

…monitoring tools- InterQual, Milliman Care Guidelines (MCG), principles of Managed Care , Computer applications, including but not limited to: Windows,