Utilization Management

To help ensure members receive the appropriate level of care, APS Healthcare performs reviews of medical and behavioral healthcare services to monitor and evaluate treatment requests. Utilizing a mind and body approach, APS’ URAC-accredited utilization management combines the use of informatics-based tools and nationally recognized clinical practice guidelines into a holistic method for effectively managing heathcare costs while achieving optimal outcomes for members.

APS’ multi-disciplinary team of clinicians, including registered nurses, registered psychiatric nurses, licensed social workers and licensed professional counselors, evaluates treatment requests using a collaborative approach to managing the comprehensive needs of each member. APS’ utilization management includes:

• Precertification
• Concurrent reviews
• Retrospective reviews

APS’ utilization review process is also used as a vehicle for identifying members who could benefit from case management. As APS reviewers gather clinical data associated with the review process, sophisticated algorithms are then used to identify cases that are appropriate for case management.

APS is capable of reviewing any type of healthcare service and can customize its utilization management program to meet a company’s specific needs.