Medical management model

Utilization Management

Our Utilization Management (UM) program uses an integrated medical management model based on the physical, behavioral and social needs of members. Using evidence based guidelines, the UM program, facilitates the delivery of the most appropriate medically necessary care to members in the most cost-effective, least-restrictive setting. UM works in collaboration with other departments, such as Case Management and Condition Care to help drive optimal outcomes.

Care management model

Our member-centric care management model integrates behavioral, physical and social factors into each individual member’s plan of care. Our model features the early identification of needs, continuous assessment of health, and a member home approach that promotes collaboration among members, family, service coordinators, provider and community resources.

This approach to care management was specifically designed to meet the needs of Medicaid recipients.

To learn more about our Utilization Management program or our Care Management Model, please see your Provider Manual or contact your provider representative.