Utilization Management

MedCom Care Management’s Utilization Management program is URAC accredited and follows nationally recognized, evidence-based MCG Health care guidelines. MedCom Care Management’s team provides an integrated and systematic approach to the assessment, monitoring and evaluation of key indicators, and improvement of health care services provided to participants. We serve as advocates to participants to help them better understand their benefit plan and the healthcare system. Our nurses answer questions and help guide participants before, during and after medical interactions. 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, as well as 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.

Medical Necessity Review Request