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Utilization Management

Utilization Management


Flexible solutions to streamline operations

Health plans, UM companies and managed care organizations alike are looking to streamline their operations and process service requests as efficiently as possible. Pre-authorizations, continuation of care and medical necessity evaluations are increasingly a challenge for many payer organizations. With a scarcity in nursing and physician advisor resources, plus volume fluctuations, it’s increasingly tough for many organizations to effectively staff for and manage these critical functions. And with many demands on in-house Medical Directors, many payers are increasingly partnering with companies like AllMed for processing their incoming service requests.

AllMed has been supporting utilization review and case management departments for over 20 years, providing flexible services that align with your needs. Whether it be full-spectrum UM or denial management to support your in-house nursing resources, we work closely with you to align our workflow with your needs. And we cover the spectrum of standards as dictated by your clinical protocols, including in-house medical policy, plan language, published care guidelines and latest standards of care.

All of these services are performed by our in-house team of UM nurses, physician advisors and clinical copy editors. Our team of Medical Directors and Staff Physicians provide clinical quality oversight to all review operations, including case-related troubleshooting as well as Inter Rater Reliability (IRR) programs.

Whether you are a UM department within a health plan, a medical management organization, PBM or specialty benefits manager, we work closely with you to define your requirements, design a UM program that integrates with your systems, train your personnel. Our Program Directors and Account Managers work closely with you through pilot deployment to full volume implementation.

AllMed offers first-level pre-authorizations, concurrent reviews and appeals to align with your needs at every stage of your clinical operations processes.  Our UM services are both non-specialty matched but we also offer specialty-specific UM options for high-volume specialties and treatments, including behavioral health UM, sleep medicine, orthopedic surgeries, and drug benefits, to name a few.

All of our services are deployed through PeerPoint, AllMed’s state-of-the-art medical review portal, which embeds healthcare intelligence and automation tools that produce the highest quality reviews at industry-leading turnaround times and costs.

But what really makes us different is our people.  Our commitment to consistently exceeding our clients’ expectations through everything we do, is why AllMed’s clients remain our loyal partners, year-after year.  This is because of the special care we take to recruit the highest quality talent, train, grow and engage them in our lean management system. As a values-based company that puts culture first, our employees care deeply about each member’s health and about delivering the highest quality care.