When patients face health problems, how do they know what course of care is right for them – and how do they know the care they choose is the most effective, or the most efficient? With OptumHealth Utilization Management, you can help your customers answer those questions, satisfying them while you control medical costs.
Evaluating the Necessity, Appropriateness and Course of Health Care
By collaborating with physicians, patients, families and other health care providers, we help patients determine the right course of treatment, using a holistic approach.
- Our Utilization Review process uses nationally recognized standards to evaluate a patients’ health history and current condition to determine appropriate care.
- We provide multiple opportunities for identifying gaps or delays in care.
- Components of our three-pronged approach can be purchased individually or as a package.
- Prospective/Precertification – review of scheduled treatment(s), procedure(s) or ancillary services
- Concurrent – review of clinical information during a patient’s hospitalization and course of treatment
- Retrospective – review of clinical information using medical records after treatment or services have been provided
Making an Impact in the Workplace
Our Utilization Management program optimizes discharge planning, which leads to more timely discharges as well as more appropriate use of skilled nursing facilities, home health are and self care. This reduces the risk of acute care readmission, decreases employee time away from work and improves presenteeism.
Utilization Management nursing staff have an average of 22+ years clinical experience and 7 years experience in utilization management.
Our team manages more than 862,000 patients’ health.
Customizing Services to Deliver Value
Our customized approach ensures we meet your customers’ needs and expectations – as well as yours. We have the ability to:
- Refer to internal and external vendors and providers
- Collaborate with national providersHigh
- Manage services within any network
- Provide network steerage and advanced consumer education
As a result, we can alleviate unnecessary care, prevent the exacerbation of diseases, promote evidence-based care and help patients avoids delays in service.