Technology, Care and Expertise for Complex Claims
The utilization management services performed by Care Review allow for early identification of cases that are potentially complex or catastrophic. If the initial screening indicates a need for further assessment, Case Management services are available to provide professional planning of treatment programs.

Our Case Managers, registered nurses skilled in the language and procedures necessary to interact with the medical community, can identify choices for alternative care and arrange for referrals to social, medical and community services, negotiate costs with vendors and serve as a patient advocate to ensure high quality care while controlling overall claims costs.

The Care Review nurses are able to quickly identify potential large dollar cases and those with catastrophic diagnoses. These patients will benefit from coordination of care and the maximization of benefits when early identification takes place and intervention can be made before extraordinary changes have occurred. Nurses utilize diagnosis codes, severity of illness, medical history and psychosocial information to identify these cases.

Discharge Planning ensures that any post-discharge home care needs are met. Our nurses work with the physician and hospital to provide medically necessary services and equipment. Let our caring professional staff help put your employees at ease while effectively managing your health plan.