Proactive Utilization Management:
Quality Care & Earlier Engagement

Our integrated approach identifies high-cost care early, empowering our nurses to engage members sooner, make informed decisions quicker, and improve outcomes through a more connected member experience.

Improved Results—for Everyone

Self-funded employers need more than traditional utilization management; they need early insight that prevents avoidable spend. We deliver exactly that.

Our Utilization Management program is engineered as a proactive activation point:

Surfacing risk sooner with predictive indicators (using Johns Hopkins ACG^® System)
Guiding members earlier
Protecting plan dollars before claims ever hit
Clinical reviews supported by InterQual^® guidelines and physician oversight

Core
Capabilities

Clinical review for medical necessity

Tailored pre-certification strategy

Evidence‑based clinical guidance

Proactive high-risk case identification and intervention

Plan-driven provider network validation

Certified
Excellence

Our 3-Year NCQA Accreditation in Utilization Management reflects our commitment to quality, consistency, and compliance through rigorous clinical review and operational excellence.

48-hour average turnaround time for all expedited utilization management requests
Average less than 5-day turnaround time for standard utilization management requests

Proactive Utilization Management:Quality Care & Earlier Engagement