Utilization Management

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

Our Services positively impact care while providing savings to the plans. Our highly-specialized team of doctors and nurses determine medical necessity, location of care and appropriateness of In and Outpatient Medical, Psychiatric and Substance Abuse admissions/procedures using clinical experience and Milliman criteria.

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.

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.

Contact Us

For quick and easy contact, use the Contact Form!
Phone/Fax
: (800) 432-8421    : (407) 333-8928
Address
: MedWatch LLC
P.O. Box 952679
Lake Mary, FL 32795-2679