Medical Management

The key to great population health management is the ability to integrate quality programs that deliver better health outcomes.

 

 

 

 

Integrated Approach

 

The majority of TPA services outsource their medical management and therefore minimize the interaction between employees and nurse. Through our integration with HealthCheck360, SISCO takes a more active approach to medical management with a service model that benefits all.

 

SISCO's Model

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Member Communication

 

Encourage member communication with the Doctors & Nurses of HealthCheck360.

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Medical Management

 

Integrate TPA & Medical Management technology to enhance Nurse intervention, timing, and results complex cases.

 

Case Management

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Case Management

 

The Case Management program is a collaborative process that assesses,
plans, implements, coordinates, monitors, and evaluates options and services for complex cases.

  • Accredited by the Utilization Review Accreditation Commission (URAC)
  • Case Managers are clinically experienced Registered Nurses
  • Collaborate with providers to assess, plan, coordinate, and monitor options and services
  • Case Managers are educated in both medical and insurance processes

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Condition Management

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Condition Management

 

Condition Management helps members with complex health conditions improve outcomes through a combination of education and treatment strategies. Our team of medical professionals are committed to helping members make positive change to improve health, while increasing productivity and reducing costs. It includes: 

  • Integration with health risk assessment results to help identify at risk participants
  • Proactively identify untreated existing or potential medical conditions
  • Technology and clinical support that help monitor medication, labs, and compliance with recommended care
  • Focused on improving health outcomes and preventing complications

Utilization Management

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Utilization Management

 

Utilization Management ensures the delivery of medically necessary services and improves access to quality care. Outreach from a dedicated Registered Nurse means that evidence-based, clinical guidelines are applied to each request. 

 

  • Access to Milliman Guidelines for Evidence-Based Knowledge and Best Practices Relevant to a Broad Range of Care Settings
  • Ambulatory Care
  • Inpatient and Surgical Care
  • Home Care
  • Recovery Facility Care
  • General Recovery Guidelines (GRG)

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My nurse was truly a godsend. She helped me through my entire cancer experience. I truly thank her for her support.

PARTICIPANT