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Milliman Care Guidelines Jobs (NOW HIRING)

Mercy

Part Time RN Care Manager-Weekend

Joplin, MO

Including neonatal/infant, child, adolescent, adult, and geriatric adult patients. 6. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding ...

Mercy

Part Time RN Care Manager-Weekend

Joplin, MO · On-site

Including neonatal/infant, child, adolescent, adult, and geriatric adult patients. 6. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding ...

Mercy

Part Time RN Care Manager-Weekend

Joplin, MO · On-site

Including neonatal/infant, child, adolescent, adult, and geriatric adult patients. 6. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding ...

Mercy

Part Time RN Care Manager-Weekend

Joplin, MO

Including neonatal/infant, child, adolescent, adult, and geriatric adult patients. 6. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding ...

Mercy

Including neonatal/infant, child, adolescent, adult, and geriatric adult patients. 6. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding ...

Mercy

Part Time RN Care Manager-Weekend

Joplin, MO · On-site

Including neonatal/infant, child, adolescent, adult, and geriatric adult patients. 6. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding ...

Mercy

Part Time RN Care Manager-Weekend

Joplin, MO · On-site

Including neonatal/infant, child, adolescent, adult, and geriatric adult patients. 6. Knowledge of InterQual or Milliman Care Guidelines preferred. Why Mercy? From day one, Mercy offers outstanding ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines * Obtain the information necessary ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines * Obtain the information necessary ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines * Obtain the information necessary ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines * Obtain the information necessary ...

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Milliman Care Guidelines information

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How much do milliman care guidelines jobs pay per hour?

As of Aug 11, 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?

AspectMilliman Care GuidelinesUtilization Review Nurse
CredentialsTypically requires clinical nursing licensure and familiarity with guidelinesRegistered Nurse (RN) license, often with additional certifications
Work EnvironmentUsed by healthcare organizations for care management and policy developmentPerforms patient chart reviews, assesses medical necessity, and makes utilization decisions
Industry UsageDeveloped by Milliman for healthcare quality and utilization managementEmployed 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:
Milliman Care Guidelines jobs near you
Infographic showing various Milliman Care Guidelines job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 70% Full Time, 21% Part Time, and 7% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $75,144 per year, or $36.1 per hour.

COORDINATOR, UM (LVN)

Pomona Valley Hospital Medical Center

Pomona, CA • On-site

$35.95 - $50.59/hr

Full-time

Re-posted 11 days ago

Pomona Valley Hospital Medical Center rating

9.2

Company rating: 9.2 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

5th of 1,056 rated hospitals

Job description

Position Summary: The Licensed Vocational Nurse plays a vital role within the Case Management Department. The LVN within the Utilization Management team collaborates closely with Case Managers, support staff, insurance payers, and post-discharge vendors to ensure safe, timely, and efficient transitions of care. This coordination not only supports optimal patient outcomes but also helps ensure appropriate hospital reimbursement for services rendered. Success in this role requires a strong balance of clinical knowledge, organizational skills, and effective communication. May perform other duties as assigned.
Required Qualifications: Valid license as a Licensed Vocational Nurse issued by the State of California. High school diploma or equivalent education necessary to meet licensure requirements. One year experience in Utilization Review or Case Management discharge planning, current knowledge/use of evidence-based admission criteria tools like Milliman Care Guidelines, knowledge of common disease processes, health care delivery systems, and insurance, management of competing priorities, effective communication, time management and problem-solving, taking initiative, adaptability, flexibility, use of hospital-wide electronic medical record systems, and basic computer skills.
Preferred Qualifications: Microsoft computer applications; Acute care experience as an LVN.
Salary range: $35.95 - $50.59 hourly. Salary will be commensurate with experience.
As part of our ongoing effort to remain an employer of choice, eligible employees who work qualifying weekend shifts receive a competitive weekend rate.

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About Pomona Valley Hospital Medical Center

Sourced by ZipRecruiter

PVHMC is a nationally recognized and accredited 412-bed, not-for-profit community medical center, proudly serving residents in eastern Los Angeles and western San Bernardino counties. With four Centers of Excellence – The Robert and Beverly Lewis Family Cancer Care Center, Stead Heart and Vascular Center, Women and Children’s Center and Trauma Center – PVHMC offers residents specialized services close to home.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Pomona, CA, US

Year founded

1903

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