TRIUNE Health Group’s URAC and state-certified Utilization Review service provides prospective, concurrent and retrospective review of the medical necessity of services requested.

Proactive Utilization Review Process

With a proven proactive approach to the Utilization Review process, our team actively manages a seamless and efficient process facilitating timely and appropriate treatment. Because of our diligent approach, our utilization management has successfully delivered financial and timely outcomes to our clients.

First Level Reviews

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.  TRIUNE Health Group focuses its review activities on opportunities that impact the most prevalent and costly services. Registered nurses perform both Utilization Review and Telephonic Case Management.