Quality Care Partners’ URAC accredited program is more than a yes/no decision. Our pre-certification and concurrent review programs utilize accepted medical and evidence-based guidelines to determine the appropriateness of medical services as well as the delivery of care setting and length of stay. QCP’s knowledgeable and friendly Utilization Management nursing staff will assist your employees to access the most cost-effective treatment plan in close collaboration with the attending physician. Close concurrent review of each case allows for monitoring and interaction while facilitating the level of care appropriate for each patient. Our Medical Directors are actively involved daily to oversee our Utilization Management process.
QCP’s Standard Utilization Management consists of:
Pre-certification/ notification of upcoming services
Concurrent review of services
Coordination of transition of care and discharge planning
Retrospective review of inpatient hospital stays
In addition to standard utilization management services, QCP also utilizes our state-of-the-art system to identify those individuals who may benefit from Case Management intervention based on diagnosis or services being requested.
Our focus is meeting the needs of our clients, we are here for you the employer, and our medical management services can be customized to fit your unique needs.