Inside Managed Care Services:
Utilization ReviewEMPLOYERS® strives to assist healthcare professionals in providing the medical treatment most appropriate for an injured employee. Authorization requests are reviewed 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.