Clinical Management

The focus of our clinical management program is on the quality of patient care, optimal outcomes and medical cost.  We are distinctly different in that we do not outsource any components of our clinical services. All of our clinical management activities are supported by an in-house staff of Medical Directors and consultants.

Our program includes:

Utilization Management

Accredited by URAC, our utilization management services facilitate the utilization of cost-effective services and promote optimal outcomes through channeling to network providers, identifying potentially unnecessary services and recommending treatment alternatives. 

Early Medical Assessment

This progressive approach to medical management assures early identification of high-risk patients that would benefit from case management through a detailed data collection process.   Our early medical assessment program offers all of the advantages of typical utilization review programs, as well as early identification of case management and increased collaborative and education opportunities with providers.

Case Management

When patients with severe, chronic conditions are identified, we initiate more intensive case management activity.  The level of our interactions with patients corresponds to the specific needs of the individual.  This approach allows our clinical staff to maintain sensitivity to the individual needs of the patient while promoting cost-effective and quality care.