Utilization Review and Management
Employee healthcare benefits are a challenging and ever-changing task. One of the greatest challenges is providing high-quality, yet cost-effective care for Plan Participants.
Core Health Services is responding to these challenges through our integrated approach to utilization management which is based on three concepts:
1. A timely review of medical necessity issues
2. Determination of the appropriate length of stay
3. Negotiation of treatment plan, care alternatives and costs
Our experienced review nurses utilize nationally recognized review criteria, allowing our utilization management certifications to be as consistent as possible. Our nurses carefully review each case we receive for medical necessity and for the appropriateness of the level of care.