Utilization Management

Services

MRIoA offers services to assist with all phases of your Utilization Management (UM) programs. Our Nurses and Medical Directors can work in tandem with your internal resources to assist with overflow, or support specific needs in your UM program.

Utilization Review Services

Service Summary

We provide utilization management (UM) services and support to a number of health plans nationwide. MRIoA has the clinical resources in place to seamlessly integrate into your UM program. Cases can be sent via the MRIoA web portal, ClientTools, or we can pull cases from our clients’ system. We offer sleep, behavioral health, emergent care, & musculoskeletal services.

Nurse Review

  • Licensed nurses
  • Initial service requests, retrospective cases & prior authorizations
  • 24 hour turnaround time available; Same Day for an additional fee
  • Reviews can be completed in clients system (based on monthly case volume)
  • Based on client needs, MD services can be completed if RN is not able to approve

Medical Director Review

  • Board Certified Physicians
  • Medical Necessity & Experimental Procedures
  • Decisions based on criteria or plan language
  • 24 hour turnaround time available; Same Day for an additional fee
  • Reviews can be completed in clients system (based on monthly case volume)
  • Based on client needs, RN services can be completed prior to MD

Nurse Review Value Pillars

Nurse Review Case Study

Nurse Review ROI

Get Information Regarding Our UM Review Services

To learn more please contact:
Michael Palmer – National Marketing 800-654-2422 ext. 6456 or email michael.palmer@mrioa.com
Jeff Rollins – National Marketing 800-654-2422 ext. 6484 or email jeff.rollins@mrioa.com

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