UTILIZATION MANAGEMENT SERVICES

 

Utilization Management (UM):

 

RCMS uses nationally accepted and recognized evidence-based treatment guidelines to determine the medical necessity of treatment requests.

 

We promote quality improvement by analyzing the most efficient use of resources used in patient care processes and as a result, this helps to decrease the cost of care. Treatment requests are reviewed and patients are treated and/or referred to the most appropriate care setting.

 

We prevent over-utilization of services by assisting in and facilitating appropriate, safe and timely discharge to the most appropriate level of care.

 

Our Physician Advisors are able to communicate with treating Physicians via Peer-to-Peer Communications. This communication vehicle is initiated when there is a disagreement regarding the proposed treatment plan. The Physicians discuss various treatment options and seek to form a consensus regarding care choices which correspond to nationally approved evidence-based treatment guidelines. 

 

Utilization Management Services:

 

Our UM Services can include:

  • Concurrent Review/Continued Stay
  • Prospective Review/Prior Authorization
  • Retrospective Review
  • Hybrid UM/CM

 

 

 

 

 

Have questions?

Call us at 1-888-909-RCMS (7267) or use our contact form.

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