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Care and Utilization Management Services

Cost Effective Care Management Services

Today's employers are increasingly aware of the budgetary impact that providing employee health benefits plays on their overall corporate bottom line. Balancing quality comprehensive coverage against rising premiums that result from increased utilization and medical expenses can be a formidable task. At Vale-U-Health, we can help by managing your plan benefits with innovative care management processes and services.

We are a premier case management company, servicing self-insured employers, third party administrators and insurance providers.

Using an integrated medical management approach, we provide Utilization Review, Case Management, Disease State Management and Peer Review. Our overall program focuses on clinical quality review for selected inpatient and outpatient services that evaluate medical necessity and appropriateness of care. Key components of our program's success include:
  • A focus on Utilization Management
  • Registered Nurses for all precertification reviews
  • State-Licensed Physician Medical Directors
  • Peer Review
  • Multi-Specialty Physician Panel Review

With over 15 years of managed care experience, our team of veteran Physician Medical Directors, Utilization Review/Case Management Nurses and Quality Improvement professionals follow nationally-recognized industry standards for delivery of care, outcomes management, benchmarking, quality improvement and provider profiling. Our premier services include:

  • Utilization review/case management
  • On-site hospital concurrent review
  • Precertification of inpatient hospital confinements & surgeries, outpatient surgeries, durable medical equipment, physical therapy, speech and occupational therapies, chiropractic, home care and medical imaging, etc.
  • Retrospective Medical Claims Review
  • Second Surgical Opinions
  • Hospital Bill Audits
  • Large (Catastrophic & Chronic) Case Management
  • Diabetes Disease State Management
  • Obesity Disease State Management
  • Case management/fee negotiation with out-of-network services/providers

We are committed to helping you control your health care costs by creating cost containment strategies and solutions that will work for you and your employees. Timely analysis, dedicated real time support and the flexibility to customize a medical management program tailored to your needs, are the principles of our care and utilization management services.

For more information, call 724-379-4011.

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