Medical Management

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

Condition Management

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

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)