	Traditional Medical Management Services UTILIZATION MANAGEMENT The HealthSCOPE Benefits' utilization management program consists of precertification review, concurrent inpatient review and medical necessity review. We apply stringent criteria to all clinical reviews and medical necessity assessments. All reviews are conducted in a Utilization Review Accreditation Committee (URAC) approved unit by experienced nurses who strive to redirect care to the most appropriate care setting. CASE MANAGEMENT Our registered nurses interact closely with the patient, family, and healthcare providers to ensure that treatment plans in catastrophic cases are effective and appropriate. Nurse Case Managers with extensive clinical experience and CCM (Certified Case Management) credentials identify and negotiate lower cost treatment and placement alternatives. DISEASE MANAGEMENT HealthSCOPE Benefits uses a "best in class" approach for our High Impact disease management program. HealthSCOPE Benefits provides predictive modeling capabilities, case identification, patient stratification, coordination and facilitation of health care services for participating members. For more detailed information on this exciting program, please see our High Impact section. DEMAND MANAGEMENT Our Demand Management program is our 24/7 Nurse Careline. This program offered by HealthSCOPE Benefits helps patients make more appropriate healthcare decisions. A specially trained nurse provides information, education, and support to patients considering various treatment options. Patients become knowledgeable consumers of healthcare services through written and recorded materials. MENTAL HEALTH/CHEMICAL DEPENDENCY HealthSCOPE Benefits' Mental Health/Chemical Dependency program is designed to provide quality managed behavioral health benefits and integrated Employee Assistance Program (EAP) to employers and employees. Through our national network affiliation, HealthSCOPE Benefits offers a complete array of products and services. Back To Top

Traditional Medical Management Services

UTILIZATION MANAGEMENT
The HealthSCOPE Benefits' utilization management program consists of precertification review, concurrent inpatient review and medical necessity review. We apply stringent criteria to all clinical reviews and medical necessity assessments. All reviews are conducted in a Utilization Review Accreditation Committee (URAC) approved unit by experienced nurses who strive to redirect care to the most appropriate care setting.

CASE MANAGEMENT
Our registered nurses interact closely with the patient, family, and healthcare providers to ensure that treatment plans in catastrophic cases are effective and appropriate. Nurse Case Managers with extensive clinical experience and CCM (Certified Case Management) credentials identify and negotiate lower cost treatment and placement alternatives.

DISEASE MANAGEMENT
HealthSCOPE Benefits uses a "best in class" approach for our High Impact disease management program. HealthSCOPE Benefits provides predictive modeling capabilities, case identification, patient stratification, coordination and facilitation of health care services for participating members. For more detailed information on this exciting program, please see our High Impact section.

DEMAND MANAGEMENT
Our Demand Management program is our 24/7 Nurse Careline. This program offered by HealthSCOPE Benefits helps patients make more appropriate healthcare decisions. A specially trained nurse provides information, education, and support to patients considering various treatment options. Patients become knowledgeable consumers of healthcare services through written and recorded materials.

MENTAL HEALTH/CHEMICAL DEPENDENCY
HealthSCOPE Benefits' Mental Health/Chemical Dependency program is designed to provide quality managed behavioral health benefits and integrated Employee Assistance Program (EAP) to employers and employees. Through our national network affiliation, HealthSCOPE Benefits offers a complete array of products and services.