Utilization Review: Inpatient
Inpatient Care nurses work with patients and providers for the patients' best interests by helping to ensure appropriate care and maximizing clients' medical benefits. Nurses evaluate and determine medical necessity and the appropriate setting for each level of care. Issues explored include whether a continued stay is necessary to achieve the desired result and whether there are cost-effective alternatives available without sacrificing care. Our goal is to increase the quality of care our patients receive by making sure they obtain the right care at the right time in the right setting.
Utilization Review: Outpatient
Outpatient Care nurses focus on high-cost, high-utilization outpatient procedures. As medical technology for outpatient treatment has evolved and become more sophisticated, the volume of outpatient procedures and associated costs have risen. Employers have seen outpatient costs parallel those of inpatient costs. Outpatient care management helps our clients control these expenses.
URAC-Accredited for Utilization Management
On April 1, 2015, URAC awarded HealthSmart Care Management Solutions the Certificate of Full Accreditation for its Health Utilization Management services. URAC’s mission is to promote continuous improvement in the quality and efficiency of healthcare management through processes of accreditation and education. The URAC accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards. HealthSmart Care Management Solutions, L.P. demonstrates its commitment to quality healthcare by measuring themselves against national standards and by undergoing rigorous evaluation by an independent accrediting body.
URAC is governed as an independent third-party, and it functions as an independent third-party. URAC is organization independent of any particular stakeholder group. The URAC governing board of directors has representatives from all affected constituencies: consumers, providers, employers, regulators, and managed care industry experts.
For more on URAC, click here.
Our team of experienced Registered Nurses and physicians are available 24 hours a day to ensure the needs of patients, health plans, and providers are addressed quickly and efficiently. Our comprehensive, straightforward Utilization Management solutions include the following programs:
Emergent Admission Review
Independent Review Panels
Case Management Identification