Utilization Management

Calibrated UM Team comprises of medical personnel from physicians to certified coders.

The team reviews and validates authorization of treatment request to ensure services rendered are medically necessary.

Calibrated UM works with the clients to establish specific guidelines to an effective Utilization program and provides various reporting and statistics for continuous evaluation and trending.

Work types include:

  • Prior authorization intake
  • Pre-certification, by service
  • Retro Authorizations Reviews
  • Referral authorization requests Reviews
  • Inpatient concurrent reviews
  • Screening Criteria to determine Length of stay
  • Discharge planning
  • Inpatient retrospective reviews
  • Evaluation of potential under and over utilization