Nurse Line
We offer a 24-hour, 365-day Nurse Line where Registered Nurses are available to answer health-related questions from covered individuals. This service is particularly beneficial and included in our High Impact program where we reach out to patients with ongoing health conditions and help them to understand and manage their condition.
Traditional Utilization Management
As you might expect, we provide the full range of. "traditional" medical management programs, including pre-certification of inpatient and outpatient services, concurrent review and discharge planning. We also have specialized programs available for reviewing high-cost radiology and mental health services.
Case Management
A group of dedicated RNs manage those patients who are most ill, monitoring services and arranging treatment that improves the overall patient care and reduces Plan cost. A significant differentiator is that we have removed artificial barriers between utilization management and case management by charging a PEPM fee covering both.
High Impact ®
We utilize a wide range of tools to identify those patients with the highest risk of future cost, based on disease, co-morbidity, non-compliance and gaps in care. Once identified, our Care Managers reach out to provide self-management education, improve compliance and coordinate care. |
