Utilization Management

Registered Nurses - supported by MedWatch's Medical Director - assuring appropriate, quality care with special attention to cost containment.

Our highly specialized team of doctors and nurses determine if criteria are met for location of care, appropriateness of in & outpatient medical, psychiatric & substance abuse admissions, procedures and diagnostic testing using clinical experience and Milliman criteria to positively impact quality of care while providing savings to the plan.

Inpatient Utilization Management

Evaluates acute inpatient admissions and acute mental health and substance services using nationally recognized guidelines and criteria. This includes review of the appropriateness of treatment plans, length of stay and discharge plans on concurrent and/or retrospective basis.

Outpatient Utilization Management

Reviews and evaluates the use of outpatient health care services and procedures using Milliman guidelines and criteria. With advancements in health care allowing more procedures to be performed on an outpatient basis, Outpatient Utilization Management is more critical than ever to ensure quality of care and containment of cost.

High Cost Radiology Network and Scheduling

Our Radiology Savings Program achieves substantial savings and is integrated into our pre-certification process with immediate access to over 3,000 centers nationally, providing a savings averaging 40-65%.

Pathology Review

A full review of all biopsies, colonoscopies, MRI, CAT and PET scans to identify potential Case Management cases early and before costly treatment begins.

Advocacy & Cost/ Value Transparency

The healthcare system is ever-changing and confusing. As the employers/plans shift healthcare costs to their members it’s essential that the members become consumers of their healthcare and have tools to make the best healthcare choices for their care and their wallets. MedWatch understands the need to assist members with a unique personalized solution aimed at assisting them to navigate through the complexities of the system and find solutions that work best for them, improve health outcomes and improve the overall healthcare experience.

MedWatch Obstetrical Monitoring (M.O.M.)

Just about everything a mother does during her pregnancy can affect the baby’s growth and delivery. Many potential problems can be avoided or managed if recognized early. Services and events related to pregnancy that require precertification are monitored through the utilization intake process and if identified as a potential high risk condition, are referred to case management for further evaluation and inclusion to the program as necessary.

Want to see more?

Use our contact form to request a full Menu of Services from our client services team!