UNIONS

Clinical Reviews Your Union Can Rely On

Get expert review support to ensure your members receive the best care outcomes while meeting your fiduciary obligations.

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Expert Clinical Reviews That Put Your Members First

We apply your plan design and policies to deliver consistent, quality clinical reviews.

Unions and Taft-Hartley health and welfare plans face a unique set of healthcare management challenges. With rising healthcare costs, an aging retiree population, and cost pressures, these organizations need to manage both administrative burdens and clinical outcomes.

MRIoA provides clinical review expertise configured to your plan design and fiduciary responsibilities. We help trustees demonstrate prudent oversight, support fair coverage determinations, and manage cost variability without expanding internal administrative burden.

Engineered for the Challenges of Unions

Expert reviews aligned to your plan policies that support determinations with defensible results for every member
Reviews that meet your fiduciary obligations and ensure your members get appropriate care
We offer a robust panel of 700+ state-state licensed specialists nationwide providing expertise not typically available in-house

Collaboration with your TPA to ensure consistency and turnaround time
Full appeals and external review infrastructure to satisfy state and federal requirements
Compliance with URAC and NCQA accreditation standards

Clinical Review Services Designed for Your Members

MRIoA’s services meet the unique needs of union benefit plans.

Taft-Hartley Health & Welfare Funds

We support jointly-administered labor-management benefit plans with independent, expert reviews that meet fiduciary obligations and ensure members receive appropriate, cost-effective care regardless of their current employer.

Union Benefit Plans

From multi-employer funds to single-employer union plans, we deliver clinical reviews that help you manage cost volatility, maintain financial stability, and ensure continuity of coverage for your members.

How We Support Taft-Hartley Plans & Unions

We ensure your organization has the review types and specialist access to protect your members and manage your plan effectively.

Health Reviews

Our multidisciplinary team of pharmacy technicians, pharmacists, physicians and specialists manage initial reviews, first- and second-level reviews, peer-to-peer reviews, and external reviews. Our team works in the PBM system, API connection, or in our secure portal.

Pharmacy Reviews

Our pharmacy team of technicians, licensed pharmacists, and physicians conduct prior authorization reviews, appeals (first/second level and formulary exception), and state and federal reviews across prospective, concurrent, and retroactive timeframes. Our experts conduct peer-to-peer reviews.

Specialty Reviews

Our nationwide panel of 700+ licensed specialists across 150+ specialties provide expert reviews to ensure union members get evidence-based treatment.

High-Cost Specialty Drug Review

Our program integrates into the prior authorization process and facilitates a peer-to-peer call between the prescriber and a panel specialist. Our expert will review the prescribed medication and offer therapeutic alternatives that reduce costs without compromising care.

Where Member Health & Plan Performance Intersect

Your members get high-quality clinical reviews with quick turnaround that improves care while protecting your plan from unnecessary costs.

Member Satisfaction & Trust

Independent clinical reviews demonstrate to union members that coverage decisions are based on medical evidence, not cost-cutting—strengthening member confidence in the fund and reducing grievances.

Quality of Care

Our evidence-based clinical reviews reduce unnecessary procedures and eliminate treatment variability, ensuring members receive the most effective care for their condition. The result is faster recovery, fewer complications, and a healthier, more productive workforce.

Cost Predictability

Our services reduce medical cost volatility by identifying high-cost, low-value care before it’s delivered. We help trustees forecast expenses more accurately despite a mobile workforce with inconsistent hours.

Consistent Standards

MRIoA’s expertise and nationwide presence ensures members get the same clinical review criteria and coverage decisions regardless of state or employer, ensuring members get quality care.

Protecting Fund Solvency

Controlling unnecessary medical spend helps keep the fund financially stable despite variable contribution levels from multiple employers, which is critical when funds can’t easily adjust premiums mid-contract.

Administrative Efficiency

Outsourced UM scales with fluctuating volumes and handles multi-state licensing requirements without adding permanent staff—letting small benefits teams focus on collective bargaining and member communication instead of clinical review operations.

Perspectives for Unions

Blog

03/25/2026

4 Best Practices to Get Better Outcomes and Better Member Experiences

Outsourcing utilization management (UM) used to be a “break glass in case of overflow” decision. Outsourcing served as a response to volume fluctuations, staffing shortages, or when an independent review…

Bre Legler

Blog

01/29/2026

From Policy to Practice: What Today’s Regulatory Shifts Mean for Clinical and Pharmacy Operations

Regulatory change is no longer episodic. It is cumulative, layered, and increasingly operational. Legislative and regulatory shifts are moving quickly from Capitol Hill and state capitols into day-to-day operations. For…

Katie Clark

Blog

09/29/2025

Is your Organization Ready for Fall 2025 State Regulatory Changes?

State legislatures and regulators are moving fast, and for payers, third-party administrators (TPAs), and pharmacy benefit managers (PBMs), the business impact is real. Starting this fall and continuing into early…

Katie Clark

Protect Your Plan, Support Your Members

Learn more about MRIoA’s expertise in independent clinical reviews.

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