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What We Do - Care Solutions - Allied Care - Utilization Management - Hero Image

Right Care.

Right Time.
Right Cost.

Our URAC-accredited Utilization Management program provides medical necessity review to ensure appropriate care at the appropriate time in the appropriate setting.

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Smarter Reviews for Healthier Members and Healthier Plans

Allied Care’s Utilization Management team reviews inpatient and outpatient procedures for medical necessity, using benchmarks from MCG Health and guided by our Total Quality Management Program.

Reviews are handled by:
  • Registered nurses with 10+ years of clinical experience.
  • Board-certified physician reviewers.
  • Internal and external panels of practicing physician specialists.
Program Highlights
  • Proprietary software facilitates all steps of the review process.
  • Automatic referrals to Case Management for high-risk members.
  • Specialized review teams for behavioral health, oncology, rehab, transplant, and pain management.
  • Customizable rules for group-specific goals and in-network optimization.
Result:

Quality care for members, reduced unnecessary costs for the plan.

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What We Do - Care Solutions - Allied Care - Utilization Management - CTA Image

Average Utilization
Management ROI:

12 : 5 : 1

Clinical Precision.
Cost-Effective Results.

Partner with Allied Care to make Utilization Management a true driver of quality health outcomes and measurable plan savings.

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