Delivering an integrated care management
solution
UMR is unique within the industry in that we provide
complete and fully integrated care management solutions to self-funded
employers. We understand the need of employer groups to provide quality health
care options to their employees while also keeping costs in line. With a staff
comprised of health coaches, registered nurses, physicians and support staff, we
work to provide members with effective and efficient care management programs
while moderating employer expense. This, in turn, creates a positive return on
investment.
Our primary efforts are to drive the
following:
- Provide the right care at the right time for
members
- Enhance members’ safety as they use the health
care system
- Increase members’ ability to be knowledgeable
consumers and effective managers of their own health
- Control health care costs
Case management
Our case
management program is designed to aggressively manage large and/or catastrophic
health care claims. We use state-of-the-art predictive modeling tools to
identify cases when accumulated costs hit a specified percentage of their stop
loss specifications.
Disease management
Our
disease management program is based on skilled nurse educators working
one-on-one with members to educate them on managing their chronic condition. As
a result, members’ compliance with their treatment plans improves, as do
employer savings.
Health and wellness
Our health and wellness program identifies members who may be at high risk
for chronic disease in the future. We engage them to adopt healthier lifestyles
that can help prevent the onset of serious health conditions.
Maternity management
Our
goal is to promote the delivery of healthy, full-term babies by educating
expectant mothers to practice good health habits, ensure they obtain and
maintain optimal prenatal care, identify those who may be at high risk for
complications and manage high-risk pregnancies through the case management
process. A case manager is available throughout the pregnancy and
post-partum period to answer questions or discuss issues of
concern.
NurseLineSM
NurseLine is a triage call center that provides
members with personalized, caring and expert support to empower them to make
more informed health care decisions. Our registered nurses have an average of 15
years clinical experience and employ proven coaching techniques to help members
receive the right care and medication and make healthy lifestyle
choices.
Utilization management
Using compassion, medical expertise and technology, our utilization
management process ensures consistency, timeliness and cost savings. We keep a
close eye on financial implications so members receive the appropriate care at a
reasonable price.
Independent medical review
Our independent medical review panel is comprised of
more than 600 physicians who provide expert opinions on the medical
appropriateness of requested services. Because of the breadth and depth of our
independent medical review panel, we are able to provide high quality services
in an efficient, timely and accurate manner.
