Utilization Management

 eQCare® Utilization Management (UM) services assist health plans by providing a multi-faceted approach to managing requests for medical services ensuring the services are medically appropriate and necessary through the use of evidence-based clinical guidelines and physician input. Utilization Management workflows and processes allow requests for services to be initiated through multiple channels including web entry, fax and/or telephonic submission supported by a network of professional service representatives backed by a large clinical staff of nurses and physicians.

At-a-Glance: Utilization Management Services Overview

• Medical necessity reviews utilizing nationally recognized InterQual^® criteria.
• A team of specialty matched physician reviewers.
• Prior authorization, concurrent, and retrospective reviews.
• Ability to document and track peer-to-peer conversations, reconsideration reviews and  multi-level appeal processes.
• Multi-faceted ability to receive UM requests via web-based entry on a provider portal, call center and/or fax submission and tracking.
• A program accredited in Health Utilization Management by URAC.
• And, much more.

eQHealth Solutions has been providing UM services for more than 20 years. Each day, we make over 2,000 utilization management decisions.

We understand government and commercial UM practices and are a trusted partner to our clients by providing consultation and services that deliver quality, efficient and cost-effective care.

Why Adopting Utilization Management Service is Important for Your Organization?

Safeguarding your organization and planning to prevent unnecessary and inappropriate medical care is critical to a healthy and successful financial outcome for your organization and your members. While maximizing the quality and cost efficacy of health care services, eQHealth’s Utilization Management Services keeps members’ best interests at heart by ensuring expert clinical guidelines are followed and patient safety is always put first.

What Sets eQHealth Solutions' Utilization Management Solution Apart From the Rest?

At eQHealth Solutions, our focus is on the holistic management of the member. By working closely with discharge planners, facilities, and member physicians, we begin planning for discharge at the time a patient is admitted into a healthcare setting. Our process is tightly integrated to ensure communication between our nurses and case managers is seamless to provide the best care. This process insures a smooth transition to the next level of care and helps avoid costly re-admissions. On a daily basis, our nurses work closely with our medical directors to ensure the best level of care is being provided at the right time and at the right place.