Utilization Management  |  Case Management
Health & Wellness  |  Analytic Services

Utilization Management

HealthQuest utilization management evaluates medical necessity, appropriateness of setting, and the efficiency of healthcare services, procedures, and facilities under the provisions of client-specific health benefits plan. Our focus is enabling patients to receive appropriate, medically necessary healthcare, while maximizing revenue.

HealthQuest is uniquely experienced in this area. More important, we understand the questions and problems faced by healthcare organizations in an evolving consumer-driven marketplace. This allows us to help you more effectively manage and contain medical costs with ideal evaluations of proposed treatment plans that are designed to provide:

• Early identification of high-risk cases
• Earliest application of trigger lists, customized to meet each client’s requirements
• Early identification and coordination of discharge planning needs
• Appropriate stop-loss coordination of potential high-cost cases

Our program uses professionally recognized standards for evaluating treatment plans that include these capabilities:

• Inpatient admissions: including acute care, sub-acute care, and behavioral health and substance abuse
• Concurrent review
• Discharge planning