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Medical Management

Cut Costs & Provide Better Care With Medical Management

URAC AccreditationMedical Management is an umbrella term used to communicate a collaborative process to help patients navigate the healthcare system. The goal is to oversee and ensure the quality of the relevant care while promoting appropriate utilization management of medical services by reducing costs and using plan resources. Patients receive the best possible care based on medical necessity. Utilization management assures that the level of care is appropriate to the health need, and repetitive, unnecessary or inappropriate services and costs are minimized or eliminated.

Managing numerous requests for medical treatment within a network is a highly complex challenge with big implications for cost and effectiveness. Finding a value-based approach to utilization reviews that approves the right, evidenced-based treatments is critical. Additionally, managing unique cases and appeals process management through a strong provider network puts even more stress on your organization. eQHealth Solutions is here to collaborate with your organization to help decrease your burden by managing your utilization review and prior authorization needs.

Our Utilization Review (UR) and Utilization Management (UM) workflows and processes include a network of professional service representatives backed by a highly experienced clinical staff of nurses and physicians. Our services, delivered via online web portal, fax and/or telephone, help health plans by providing a means to monitor the appropriateness of all medically necessary and covered services for pre-service care, concurrent review, and post-service care delivered to your members in alignment with your plan guidelines.

Whether you are a health plan, a self-insured employer or another entity seeking medical management, eQHealth Solutions offers a full range of services.


Medical Management Services



Utilization Management

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Complex Case Management

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Chronic Condition Management

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Have any questions? Call us toll-free.1-800-720-2578