Utilization management is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities. It provides a safeguard against unnecessary and inappropriate medical care. At GloNet, our experts review patient care from perspectives of medical necessity, quality of care, appropriateness of decision-making, place of service, and length of hospital stay.

Accurate Peer Review

GloNet’s staff of experienced physicians, nurses, and peer reviewers expertly utilizes advanced analytical tools and apply industry standards and best practice guidelines to validate medical necessity and appropriateness of care. However, to ensure that our expert staff compares apples to apples, we utilize only physicians to review medical treatment plans, nurses to review nursing standard of care, and so on. It is our belief that this is the only way to achieve a true peer review.

High Risk Patients

Since part of our aim is to help contain cost, we diligently strive to identify those high risk patients who would benefit from more in-depth care management. Once identified, these individuals are referred to case management services – with GloNet, or another provider of choice.

GloNet’s Utilization Review Program includes:

  • Concurrent Review
  • Discharge Planning
  • Post Claims Review
  • Retrospective Review
  • Identification of high dollar and/or complicated cases
  • Physician Advisor Program
  • Appeals Process
  • Facilitate Referrals
  • Obtain prior authorizations for services

We are happy to customize our program to your specific needs. Contact us to learn how.