Determines medical necessity of medical services.
The clinical professionals providing Utilization Management services use established
national medical guidelines to evaluate the medical necessity for hospitalizations
and outpatient services and the appropriateness of the overall treatment plan.
The programs offered by Interactive Medical Systems combine the expertise of
registered nurse reviewers, board certified Medical Directors and a panel of board
certified, practicing physicians to help direct patients and their
providers towards the most cost effective, quality treatment available.
Key Features & Advantages:
Medical Director and Panel of Specialists
- Utilization Management is accredited by the Utilization Review
Accreditation Commission (URAC), the highest level of accreditation in the
- The program sets the highest priority on timeliness, accuracy, quality of care and cost-effectiveness.
- Each admission evaluation is conducted by a registered nurse reviewer who
applies established medical criteria that meets national and community standards.
- The reviewers interact with attending physicians to agree on treatment plans and appropriate
lengths of stay. Cases are continually monitored throughout the hospital stay to assure
quality and appropriateness of care.
- All nurse reviewers have multiple years of clinical experience. They view the best
patient outcomes as their goal.
Overseeing the Utilization Management Programs are board-certified Medical Directors who are
diplomats of the American Board of Quality Assurance and Utilization Review Physicians.
The programs also offer the expertise of board-certified, practicing physician specialists.
Interactive Medical Systems clients benefit from a proactive service that leads to fewer
emergency room and physician visits, and ultimately reduced costs. Patients benefit from
access to information on health care issues 24 hours a day, 7 days a week.