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Utilization Review
Coventry’s URAC and state-certified Utilization Review service provides prospective, concurrent and retrospective review of the medical necessity of services requested. Registered nurses complete first level reviews based on national, evidence-based guidelines, and coordinate reviews with our expert Physician Advisors when such guidelines are exceeded or unmet. Registered nurses perform both Utilization Review and Telephonic Case Management as regulations permit, providing a seamless and efficient process to facilitate timely and appropriate treatment.
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related services
Field Case Management
Expert FCM staff achieves some of the best outcomes in the industry.
Telephonic Case Management
Ensures appropriate treatment and return–to-work plans are established.