Case Management & Utilization Management Program Design
As patient needs grow more complex, Case Management and Utilization Management are essential to delivering evidence-based care, improving patient satisfaction, and strengthening the financial performance of healthcare organizations.
Our clinical and operational experts redesign structures and processes to ensure patients receive the right care, at the right time, in the right setting – driving optimal outcomes and appropriate reimbursement. By breaking down silos and reducing inefficiencies, we help shift from reactive to proactive cultures to achieve better resource utilization, interdisciplinary integration, and high quality of care. Our implementation and change management support moves organizations from a hospital-based function to one that provides care management across the continuum.
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Care meets payment: Teaching hospital dramatically reduces medical necessity denials across payers
When medical necessity denials doubled, leaders developed a proactive plan for denial prevention. It’s paying off. We share how.