Utilization Management

A medical services solution with benefits for your employees and your bottom line

The Utilization Management Program evaluates and manages the quality and cost of healthcare services delivered to customers of Community Health Partners. A local staff consisting of physician medical advisors, registered and licensed practical nurses review inpatient and outpatient services to determine medical necessity, utilizing “gold standard” clinical criteria. Authorization turnaround time is 1-2 business days, depending on receipt of appropriate documentation to substantiate medical necessity.

Program components include:

  • Pre-admission and admission review.
  • Concurrent hospital stay review.
  • Case Management and Disease Management (SmartChoice).
  • Referral authorization for a specialist or out-of network care.
  • Outpatient service and ambulatory review.

For more information on Utilization Management and other medical services solutions from Community Health Partners, call 239.659.7770, between 8 am – 5 pm.

Click the form links to the right in order to fill out the Pre-certification request form and fax to 239.659.7785.