UTILIZATION MANAGEMENT

FOCUS ON APPROPRIATE, QUALITY CARE

The scope of our Utilization Management program is to monitor and evaluate the appropriateness of care for all services provided to all members at all levels of care.

We are committed to quality of care for all members served. Our program includes (but is not limited to) prospective review, concurrent review, retrospective review services, and discharge planning.

This complete process enables CareValent to ensure that members are receiving high-quality and appropriate care while managing high-cost care and hospitalizations. Our automated trigger diagnosis program identifies members with certain chronic conditions and catastrophic diagnoses, which are referred to either our Case Management or Disease Management Programs.