Utilization Review and Care Management Services for Health Plans

Utilization Review and Care Management Services for Health Plans

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Premier Home Health Care Services, Inc. provides population health management services for dual-eligible and Medicaid health plan members inclusive of all required enrollment and reassessment services, development of the member center plan of care, and ongoing interdisciplinary team member care management services in a PMPM shared risk environment.

Utilization Review and Care Management Services for Health Plans

Premier operates as a delegated entity under contract with health plans and provides utilization review (UR) and care management services for dual-eligible, managed long-term care and Medicaid health plan members. Services include:

  • Utilization Review (Enrollment/Initial, Reassessment, Change-in-Condition)
  • Person Center Service Plan Development and Management
  • Prior Authorization
  • Concurrent Authorization
  • Retrospective Review
  • Initial Adverse Determination
  • Member Internal Appeals
  • Final Adverse Determination
  • Fair Hearing Representation

Premier interdisciplinary care management teams provide outcome-focused utilization management services to assure both high-quality member care experiences and health care outcomes, while simultaneously managing PMPM medical spending budgets in a shared risk environment.

Call Premier Home Health Care Services today at 1-866-263-5118 to learn more about our care management services.