Utilization Review Management

Our mission is to provide customized Utilization Review Management to suit our individual client’s needs by utilizing cutting-edge techniques and tools, thereby providing a viable alternative to traditional Utilization Review Management Services. We are dedicated to providing our clients and patients with unique responses to their individual healthcare needs and concerns.

We understand that the most effective, most well received, Utilization Review Management programs are "Patient-Centric". Therefore, our programs focus on identification of patients who could benefit from the individualized attention and assistance of a Professional Registered Nurse in controlling their health condition(s). Any patient with any health condition who is not currently utilizing “Best Practices Medicine” would be a candidate for our program. Once identified as a potential candidate for our services, the information available is screened by a case coordinator.

The primary goal of this screener is to determine the likelihood that one of our professional Registered Nurses could either improve the quality of health care the patient is receiving, and/or decrease the cost of the health care the patient is receiving without compromising the quality of health care being provided. The cost of this screening is included in our administrative fee.

Our program is tailored to the uniqueness of not only each patient, but also each client. We will be as aggressive or as passive in our interventions as you choose. We will bring our expertise, information, and suggestions to you, but ultimately it is you who will decide how much of an investment you are able/willing to make and where you wish to deploy that investment.

Advantages of our Utilization Review Management:

• We use only nurses and physicians, not foriegn call centers. We are the only Utilization Review Management Company that does so.
• Match customer’s needs with customized programs and offerings.
• One nurse working with one patient through their continuum of care.
• We reach every single person pre and post hospitalization…no one else does.
• Transplant management plus physician involvement always equals huge financial impact.
• In house nurse on call, 24 hours a day, because we could not find a vendor that would take specific info for each client
• High nurse- to- employee lives ratio. We have one RN per 3000 employee lives….Blue Cross Blue Shield has one per 12,000 employee lives. United Healthcare has one RN per 60,000 employee lives.   We have up to 20 times more available nurses.
• Competitively priced.
• Guaranteed Preformance of $3.00 in savings returned for every dollar spent.

Group #1

Self-funded trust went from a 3.5 million deficit to a 4.5 million surplus in year 1 utilizing our Utilization Review Management services (as the only change made)! Year 2 the Plan made significant ENRICHMENTS to benefits offered to their members and still had an additional REDUCTION in claims costs of 1 million dollars.

Group #2

Claims costs REDUCED by over 24%, and beat anticipated trend by over 34%. Saved over 2.4 million in year 1 with the only change being adding us.

CONTACT US

You can contact us by filling out this form and we'll get back to you as soon as possible.

Remember we guarantee a $3.00 in claims savings returned for every dollar spent for Utilization Review Management