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