INTEGRATION
INNOVATION
IMAGINATION
SOLUTIONS INETCARE ABOUT NEWS CONTACT Inetico Login

INETICARE

      

 

 

Utilization Management (UM)


Utilization management encompasses many aspects of evaluating the plan member care while balancing the plan administration.  With the assistance of the INETICARE Nurse, companies can better manage costs and improve clinical outcomes.

INETICARE UM Results

INETICO's approach to UM has documented claims savings to help reduce overall healthplan premiums.  Using the INETICARE UM program, our trained RN Nurse case managers help ensure the following: 

  • Only patients with medical need for hospitalization are admitted.
  • Proposed treatment plan is of acceptable quality and customary for the diagnosis ancillary services.
  • Inpatient stays are necessary and appropriate.
  • Diagnostic tests are appropriately ordered. 
  • Quality of treatment plan is evaluated. 

INETICARE''s Utilization Management encompasses the following specialties:

  • Hospital Inpatient and Outpatient Procedure
  • Precertification
  • Prospective review
  • Retrospective review
  • Concurrent review
  • Proactive Treatment & Discharge Planning Assistance
  • Specialty Peer Review
  • Medical Record and Claim Review
  • Online, real time reporting

Utilization management encompasses many aspects of evaluating the plan member care while balancing the plan administration.  With the assistance of the INETICARE Nurse, companies can better manage costs and improve clinical outcomes.