Utilization Management:
Your Gatekeeper to Appropriate Care

Helping members access appropriate care that is medically necessary and cost-effective

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Quality Differentiates

  • URAC Accredited since 1997
  • Maintains State Licensure in all states as required.
  • Milliman Guidelines
  • Experience & Expertise
  • Continual Monitoring of Treatment Plan & Early Discharge Planning

Having URAC Accreditation and all required state licensures demonstrates our commitment to excellence and supports that the determinations we make are appropriate for quality, effectiveness, and cost of patient care.

A Higher Standard of Utilization Management

MedWatch’s team of experienced clinicians leverage our URAC Accreditation, licensure, and nationally recognized guidelines to improve patient care and provide early identification and risk mitigation for potentially high-cost events.

Inpatient Utilization

Addresses medical, surgical and behavioral health admissions, level of care, length of stay, including discharge planning.

Outpatient Utilization

Evaluates outpatient services, including surgical care and diagnostic tests for medical necessity and appropriateness of care and same day op services.

The Value of More

Additional programs are available within Utilization Management to mitigate risk and increase savings, helping to ensure members are receiving the most appropriate care at the right time, in the right place, for the right cost.

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High-Cost Radiology Network and Scheduling

Our Radiology Savings Program achieves an average savings of 40-65% with immediate access to over 3,000 centers nationally

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MedWatch Obstetrical Monitoring

Services and events related to pregnancy are monitored through the utilization intake process while high risk conditions are referred to case management for further evaluation as necessary

Readmission Prevention
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Readmission Prevention

Improves the coordination of care between settings to reduce recovery time, prevent readmissions, and lower costs.

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Pathology Review

A full review of all biopsies, colonoscopies, MRI, CAT and PET scans to identify potential case management opportunities early and before costly treatments begin

Explore MedWatch Services

With more than two dozen programs and services designed to mitigate risk and enhance clinical and financial outcomes, MedWatch offers truly comprehensive population health management. Click below to explore our other services.

Pathways Concierge

Utilization Management

Case Management

Disease Management

Claims Solutions

Ancillary Services

Direct Contracts

Want to See More?

Request your own copy of our Services Overview!

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