Utilization management

Creating pre-certification requirements or alternative benefit solutions can reduce overall health plan costs.
utilization-management

Health Utilization Management

Expires 01/01/2026

MedCom Care Management’s Utilization Management program is URAC accredited and follows nationally recognized, evidence-based MCG Health Care Guidelines.

Utilization Management is used when a health plan needs medical necessity approval for certain medical services, procedures, and inpatient hospitalization. Personify Health may also be able to offer other solutions to help save the individual and the health plan money, while maintaining the quality of care and reducing the cost of the health plan overall.

We advocate for participants

Our nurses answer questions and help guide participants before, during, and after medical interactions to help them better understand their benefits and the healthcare system. We work in a timely manner to avoid delay or disruption of care, and are sensitive to the anxiety that illness can generate. Delivering care with a sincere concern for the individual’s welfare, our team seeks the best for the patient’s physical and emotional status and the financial impact on the plan.

MedCom Care Management does not engage in the practice of medicine; nor do they act to impinge upon or encumber the independent medical judgment of treating physicians or other health care providers. Implementation of this program should not be construed to imply otherwise.

Let’s talk

Have questions about whether MedCom is right for your organization? Reach out and one of our sales team will be in touch soon. We’d love to learn more about your organization and to see if Medcom can help.

For all support-related inquiries, please contact our medical management department.

Lets Talk

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