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Medical Management Programs

• Utilization Management
• Case Management
• Medical Claim Review
• Healthy Pregnancy
• Disease Management
• Nurse Support Services

Medical Management

Our medical management program provides an appropriate level of support to all plan members, from those with simple, everyday concerns to those with chronic or catastrophic conditions. The goal of our medical management program is to assist plan members in receiving high-quality care, provided in the most appropriate setting, while carefully managing costs.

We employ a multi-faceted approach, including predictive modeling, to identify and enroll members into appropriate programs. You can also refer employees to programs included in your benefit plan; in many instances, employees can also self-refer and enroll.

• Utilization Management
• Case Management
• Medical Claim Review
• Healthy Pregnancy
• Disease Management
• Nurse Support Services

You and your employees can access additional medical management provider resources through the National Ancillary Network and Medical Specialty Network.