SOLUTIONS | CASUALTY | WORKERS’ COMPENSATION | MANAGED CARE
Utilization review
Our nurses ensure treatment is appropriate and helps injured employees recover and return to work.
What we do
Our utilization review nurses examine treatment requests, where allowable by law, and can validate or negotiate the necessity, setting, frequency, intensity and duration of care. Unnecessary and inappropriate medical care can have detrimental effects on patients including delayed recovery, additional health issues, stress and anxiety. Our nurses evaluate each request against evidence-based guidelines to ensure care is medically necessary and helps injured employees get back to work.
Our experienced team completes prospective, concurrent and retrospective reviews. If the treatment falls outside of the medical guidelines, the nurse will engage a physician advisor who will consult with the treating provider on alternative strategies. Our physician advisors enhance the review process and provide medical and pharmaceutical expertise to ensure clients and their injured employees stay on the right path to achieve the best possible outcomes.
We also provide pharmacy utilization review services that work to control costs and discontinue inappropriate and long-term drug use.
Our team receives extensive, ongoing training and our organization is URAC-accredited, attesting to the high quality of our review process.
Reviewing treatment requests before the onset of care can help employers lower medical expenses.
Results
54%
of treatment requests were denied/withdrawn following review
5:1
return on investment
