What is Navigate UM?
Navigate UM is a utilization management program that uses a combination of insights and innovation to ensure patients receive proper medical and behavioral healthcare. This fully-integrated utilization management program covers prior authorization, concurrent review of inpatient admissions, transition of care assessment and appeal management.
We understand that each organization is unique, so to best meet your needs, we offer the flexibility of selecting Navigate UM as a standalone offering.
What we offer:
Our expert team of intake specialists, nurses and physicians perform these services, which are compliant with NCQA standards, and offer a comprehensive suite of reports to track trends and identify opportunities.
Providing comprehensive peer-to-peer review
Efficiently managing turnaround times
Providing medically necessary care based on nationally recognized clinical guidelines
Preventing fraud, waste and abuse
Referring members into care management
Minimizing readmission through transition of care
Who can benefit from Navigate UM?
- Health plans
- Employer groups
- Government entities
- Third-party administrators
Please note that individual program implementation is dependent on plan size and other factors. We will partner with you to create a custom solution that best fits the needs of your unique population.