Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization. Maintain accurate records of all patient ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization. Maintain accurate records of all patient ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization Maintain accurate records of all patient ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization Maintain accurate records of all patient ...
Utilization Review Nurse
Alpharetta, GA · On-site
Assess medical necessity using established clinical guidelines such as InterQual, MCG (Milliman Care Guidelines), and payer-specific criteria.Review medical records, physician documentation ...
Utilization Review Nurse
Alpharetta, GA · On-site
Assess medical necessity using established clinical guidelines such as InterQual, MCG (Milliman Care Guidelines), and payer-specific criteria.Review medical records, physician documentation ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization. Maintain accurate records of all patient ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization. Maintain accurate records of all patient ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization Maintain accurate records of all patient ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization Maintain accurate records of all patient ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization. Maintain accurate records of all patient ...
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization. Maintain accurate records of all patient ...
Nurse Case Manager, Utilization Management
Manhattan, NY · On-site
$89K - $106K/yr
... Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization • Maintain accurate records of all patient ...
Nurse Case Manager, Utilization Management
Manhattan, NY · On-site
$89K - $106K/yr
... Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization • Maintain accurate records of all patient ...
Case Management Nurse
Manhattan, NY · On-site
Knowledge of Milliman Care Guidelines * Knowledge of CMS guidelines for post-acute plaements * Communicate with Attending Physicians on admission guidelines * Provide real time interventions to ...
Case Management Nurse
Manhattan, NY · On-site
Knowledge of Milliman Care Guidelines * Knowledge of CMS guidelines for post-acute plaements * Communicate with Attending Physicians on admission guidelines * Provide real time interventions to ...
... Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization • Maintain accurate records of all patient ...
... Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization • Maintain accurate records of all patient ...
... Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization • Maintain accurate records of all patient ...
... Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization • Maintain accurate records of all patient ...
... Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization • Maintain accurate records of all patient ...
... Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization • Maintain accurate records of all patient ...
Case Management Nurse
Brooklyn, NY · On-site
$64.74/hr
Knowledge of Milliman Care Guidelines * Knowledge of CMS guidelines for post-acute plaements * Communicate with Attending Physicians on admission guidelines * Provide real time interventions to ...
Case Management Nurse
Brooklyn, NY · On-site
$64.74/hr
Knowledge of Milliman Care Guidelines * Knowledge of CMS guidelines for post-acute plaements * Communicate with Attending Physicians on admission guidelines * Provide real time interventions to ...
Case Management Nurse
Brooklyn, NY · On-site
Knowledge of Milliman Care Guidelines * Knowledge of CMS guidelines for post-acute plaements * Communicate with Attending Physicians on admission guidelines * Provide real time interventions to ...
Case Management Nurse
Brooklyn, NY · On-site
Knowledge of Milliman Care Guidelines * Knowledge of CMS guidelines for post-acute plaements * Communicate with Attending Physicians on admission guidelines * Provide real time interventions to ...
Utilization Review Registered Nurse : On Site Position
Meeker, CO · On-site
$33.50 - $49/hr
InterQual, Milliman Care Guidelines), and payer specific guidelines. - Communicate effectively with attending physicians, residents, and other healthcare providers regarding medical necessity ...
Utilization Review Registered Nurse : On Site Position
Meeker, CO · On-site
$33.50 - $49/hr
InterQual, Milliman Care Guidelines), and payer specific guidelines. - Communicate effectively with attending physicians, residents, and other healthcare providers regarding medical necessity ...
Utilization Review Registered Nurse : On Site Position
Meeker, CO · On-site
$33.50 - $49/hr
InterQual, Milliman Care Guidelines), and payer specific guidelines. - Communicate effectively with attending physicians, residents, and other healthcare providers regarding medical necessity ...
Utilization Review Registered Nurse : On Site Position
Meeker, CO · On-site
$33.50 - $49/hr
InterQual, Milliman Care Guidelines), and payer specific guidelines. - Communicate effectively with attending physicians, residents, and other healthcare providers regarding medical necessity ...
Is able to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines. * Is able to understand and apply coverage guidelines and benefit limitations. * Familiar with ...
New
Is able to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines. * Is able to understand and apply coverage guidelines and benefit limitations. * Familiar with ...
New
RN Case Manager (Casual) - Case Management
San Diego, CA · On-site
$61.22 - $105.37/hr
Experience in a pediatric acute hospital Familiarity with Interqual or Milliman Care Guidelines Experience navigating the electronic medical record (Epic) The current salary range for this position ...
RN Case Manager (Casual) - Case Management
San Diego, CA · On-site
$61.22 - $105.37/hr
Experience in a pediatric acute hospital Familiarity with Interqual or Milliman Care Guidelines Experience navigating the electronic medical record (Epic) The current salary range for this position ...
RN Case Manager (Casual) - Case Management
$61.22 - $105.37/hr
Experience in a pediatric acute hospital Familiarity with Interqual or Milliman Care Guidelines Experience navigating the electronic medical record (Epic) The current salary range for this position ...
RN Case Manager (Casual) - Case Management
$61.22 - $105.37/hr
Experience in a pediatric acute hospital Familiarity with Interqual or Milliman Care Guidelines Experience navigating the electronic medical record (Epic) The current salary range for this position ...
RN Case Manager (Casual) - Case Management
San Diego, CA · On-site
$61.22 - $105.37/hr
Experience in a pediatric acute hospital Familiarity with Interqual or Milliman Care Guidelines Experience navigating the electronic medical record (Epic) The current salary range for this position ...
RN Case Manager (Casual) - Case Management
San Diego, CA · On-site
$61.22 - $105.37/hr
Experience in a pediatric acute hospital Familiarity with Interqual or Milliman Care Guidelines Experience navigating the electronic medical record (Epic) The current salary range for this position ...
... Milliman Care Guidelines, InterQual (preferred)
... Milliman Care Guidelines, InterQual (preferred)
Milliman Care Guidelines information
See salary details
$9.13 - $15.14
19% of jobs
$17.69 is the 25th percentile. Wages below this are outliers.
$15.14 - $21.15
14% of jobs
$21.15 - $27.16
6% of jobs
$27.16 - $33.17
4% of jobs
The median wage is $34.98 / hr.
$33.17 - $39.18
21% of jobs
$42.99 is the 75th percentile. Wages above this are outliers.
$39.18 - $45.19
16% of jobs
$45.19 - $51.20
9% of jobs
$51.20 - $57.21
5% of jobs
$57.21 - $63.22
3% of jobs
$63.22 - $69.23
1% of jobs
$69.23 - $75.24
1% of jobs
$9
$36
$75
How much do milliman care guidelines jobs pay per hour?
As of Aug 13, 2026, the average hourly pay for milliman care guidelines in the United States is $36.13, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $44.95 per hour, depending on experience, location, and employer.
What are the key skills and qualifications needed to thrive as a Milliman Care Guidelines specialist, and why are they important?
To thrive as a Milliman Care Guidelines Specialist, you need strong clinical knowledge, experience in healthcare utilization management, and familiarity with evidence-based care criteria, often supported by a nursing or healthcare degree. Proficiency in using the MCG (formerly Milliman Care Guidelines) software, electronic medical records (EMRs), and relevant healthcare IT systems is essential. Attention to detail, analytical thinking, and effective communication are important soft skills for success in this role. These skills ensure accurate application of clinical guidelines, promote effective care decisions, and support compliance with regulatory standards.
What are Milliman Care Guidelines?
Milliman Care Guidelines, also known as MCG, are evidence-based clinical guidelines used by healthcare providers and insurers to make informed decisions about patient care. These guidelines help standardize treatment protocols, determine the medical necessity of services, and support care management processes. By using MCG, organizations aim to ensure that patients receive appropriate, efficient, and effective care while managing healthcare costs. The guidelines are regularly updated to reflect the latest medical research and best practices.
How does working with Milliman Care Guidelines involve collaboration with other healthcare professionals?
Professionals working with Milliman Care Guidelines often collaborate closely with clinicians, case managers, utilization review teams, and IT specialists to ensure evidence-based care recommendations are accurately implemented. This teamwork helps to align clinical decisions with best practices, improve patient outcomes, and streamline workflows. Regular interdisciplinary meetings, training sessions, and feedback loops are common, fostering a supportive environment where collective expertise leads to better healthcare delivery.
What is the difference between Milliman Care Guidelines vs Utilization Review Nurse?
| Aspect | Milliman Care Guidelines | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires clinical nursing licensure and familiarity with guidelines | Registered Nurse (RN) license, often with additional certifications |
| Work Environment | Used by healthcare organizations for care management and policy development | Performs patient chart reviews, assesses medical necessity, and makes utilization decisions |
| Industry Usage | Developed by Milliman for healthcare quality and utilization management | Employed by hospitals, insurance companies, and healthcare providers |
While Milliman Care Guidelines are standardized protocols used to guide clinical decision-making, Utilization Review Nurses apply these guidelines in real-time patient assessments to determine the necessity and appropriateness of care. Both play vital roles in healthcare quality management, but one provides the framework, and the other executes the review process.
More about Milliman Care Guidelines jobs
What states have the most Milliman Care Guidelines jobs?
States with the most job openings for Milliman Care Guidelines jobs include:
What job categories do people searching Milliman Care Guidelines jobs look for?
The top searched job categories for Milliman Care Guidelines jobs are:
Full-time
This job post has expired 2 days ago. Applications are no longer accepted.
Job description
Job Title
Responsibilities
Use industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide, ongoing coordination and management of service delivery through an integrated case management approach. Performs medical necessity review that includes concurrent, prospective, retrospective reviews and 1st level appeals, to ensure compliance with applicable criteria, medical policy, member eligibility, benefits and vendor contracts. Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization. Maintain accurate records of all patient/provider/vendor related interactions in designated medical management system. Apply clinical guidelines, provide recommendations and discuss cases with Medical Consultants. Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and participate in quality improvement activities as it relates to internal programs, processes studies and projects. Authorize vendor services using clinically proven criteria to make consistent care decisions. Maintain compliance with all state mandated regulations. Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services. Responsible for abiding by and supporting the care management programs in order to ensure quality and efficient clinical operations. Perform additional duties and projects as assigned by management.
Qualifications
Bachelor's degree Valid New York State Registered Nurse (RN) required. Minimum three (3) years Medical/Surgical experience plus a minimum of two (2) years Utilization Management experience required. BSN and Certification in Case Management a plus. Proficient in application and use of industry standard Utilization Management criteria (Milliman Care Guidelines), Medicare and coverage guidelines, health claims processing, medical coding. Excellent verbal and written communication skills, problem-solving, clinical assessment, care planning skills, and independent decision-making capability. Computer and organizational skills required, ability to manage competing priorities, multi-task with results-oriented outcomes and work in a fast paced environment. Intermediate skills of Microsoft Office systems preferred.
About 1199SEIU Funds
Sourced by ZipRecruiter
Industry
Insurance services
Company size
501 - 1,000 Employees
Headquarters location
New York, NY, US
Year founded
1945