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Utilization Review

Utilization Review

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:
  • Utilization Management is accredited by the Utilization Review Accreditation Commission (URAC), the highest level of accreditation in the industry.

  • 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.

Medical Director and Panel of Specialists

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.