Medical Management

Versatility and innovation are vital to managing today’s complex medical environment.

Our medical management helps Medicaid Plans administer health care resources to provide members with the appropriate and cost-effective benefits to improve their health.

Our medical management team can:

• Provide disease and case management, as well as pharmacy management
• Strive to reduce the overuse and underuse of medical service
• Develop disease management programs appropriate for the populations you serve, including diabetes, asthma, COPD and congestive heart failure
• Profile providers, including medical services and pharmacy utilization
• Study and improve systems and processes related to the provision of health care and services within health plans and health care organizations
• Minimize variations in practice by monitoring appropriateness, quality, effectiveness and accessibility of care
• Monitor and review clinical quality indicators, including HEDIS and QISMC
• Conduct prior authorizations
• Conduct concurrent and retrospective reviews
• Conduct provider and member surveys
• Credential and re-credential providers