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Utilization Management
CLINIX Utilization Management Program coordinates and simplifies claims administration when multiple payers are involved, and is designed to channel employees to preferred providers.
CLINIX differentiates itself from other clinical management programs by applying a process that assists the member through an acute care episode.
Features of the program include:
- Pre-Admission Review
- Emergency Admission Review
- Concurrent Review
- Retrospective review
- Discharge Planning
- Maternity Screening
- PreCall/ReCall Programs
- Out-Patient Review
- PPO Channeling
Our program focuses on medical appropriateness and efficiency, with the ability to offer specialty reviews.
For patients who don’t require the intensity of services offered in a hospital, CLINIX coordinates with the patients’ doctor and the admitting hospital for an early and safe discharge. Through discharge planning and Short Term Case Management, CLINIX facilitates continuation of the medical care at home.
Hospital Utilization Management offers Short Term Case Management when needs are identified for less than 30 days post discharge. CLINIX Recall program verifies that the entire home healthcare needs of the patient have been met
CLINIX has a National Medical Director, a panel of specialty physician consultants, and an experienced nursing staff. This allows CLINIX to apply many years of experience toward the accurate and efficient handling of patient care while effectively managing costs.
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