Service

Utilization Management Services

A revenue integrity service for providers who want to use prospective reviews to select the right care settings for optimized reimbursement.

 

AlignCare Needs With Reimbursement Requirements

  • Help ensure that patients receive the most appropriate level of care while reducing your risk of medical necessity denials
  • Implement concurrent authorization services for admissions 
  • Expand the number of cases you review, and focus on length of stay and highly complex cases that need specific clinical expertise
  • Conduct placement-status reviews using InterQual® or another evidenced-based, clinical decision-making tool
  • Apply additional scrutiny when decision-support tools conflict with a physician’s clinical judgement, helping ensure additional documentation for medical necessity of care
  • Track the ROI by using our reporting and analytics to keep you informed of performance 

Utilization Management in Healthcare

  • A Flexible Resource Customized to Your Needs

    • Engage our services to augment your existing staff or use our team as a complete solution. 
    • We can also provide a bridge to in-sourcing by educating and training your team, helping you build a strong internal prospective review program. 
    • We track and report on several key performance indicators so you can both assess ROI and drive continuous quality improvement in utilization management.

Our outcomes

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