Medical Management

Versatility and innovation are vital to managing today’s complex medical environment.
Our medical management helps organizations administer health care resources to provide members with the appropriate and cost-effective benefits to improve their health.

Our medical management team can:

• Provide disease and case management, as well as pharmacy management
• Strive to reduce the overuse and underuse of medical service
• Develop disease management programs appropriate for the populations you serve, including diabetes, asthma, COPD and congestive heart failure
• Profile providers, including medical services and pharmacy utilization
• Study and improve systems and processes related to the provision of health care and services within health plans and health care organizations
• Minimize variations in practice by monitoring appropriateness, quality, effectiveness and accessibility of care
• Monitor and review clinical quality indicators, including HEDIS and QISMC
• Conduct prior authorizations
• Conduct concurrent and retrospective reviews
• Conduct provider and member surveys
• Credential and re-credential providers