Utilization Management is a program (Pre-certification) is the first step in identifying high risk patients and to help insure they receive high quality care which is necessary and appropriate while avoiding unnecessary expenses. This allows the Nurses with the opportunity to provide this care while containing costs. Our Utilization Management program can be customized to meet the needs of the employer’s health plan. Services can include:

Services include:

In-patient Care Out-patient Treatment Out-patient Testing Network Direction

Durable Medical Equipment Case Management Screening Pharmacy

The goal for utilization management is to determine if the services requested to be provided may be eligible for payment by the plan.