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Inside Managed Care Services:

Utilization Review

EMPLOYERS® strives to assist healthcare professionals in providing the medical treatment most appropriate for an injured employee. We review authorization requests to confirm treatment is in accordance with nationally-accepted clinical guideline standards.

Our Medical Director and Utilization Review Physicians work in collaboration with our healthcare professionals during the Utilization Review process. Physicians may review and certify, or non-certify services requested by an injured employee’s treating physician. If a treatment requested is not appropriate for the industrial injury, it may be non-certified. Physician Advisors provide medical-necessity decisions based upon nationally-accepted clinical guideline standards.

In addition to consultation regarding medical treatment issues, our Medical Director and Physician Advisors can review claims compensability when necessary.