Care Adviser

Promoting Health, Preventing Illness and Controlling Costs

What is CARE ADVISER?

Using a full-spectrum approach, our Care Management team is committed to improving the quality of care and achieving the best outcomes for plan members and your bottom line.

Who Benefits?

TPAs, Brokers, Fully-Insured and Self-Funded Plans

Reduce costs and gain your advantage in the marketplace. RN Case Managers educate and work on behalf of groups and members to navigate through high-cost care and hospitalizations, avoiding costly care ⎯⎯ hospital
re-admits, wasteful practices, etc.

MGUs and Stop-Loss Carriers

Set reserves and be more strategic with your renewals using robust Care Management summary reporting. Enjoy lower costs with Automated Trigger Discounts, automating CM referrals generated at Pre-Cert.

Second Opinion

Physician reviews from experts across multiple specialties are facilitated and delivered to you for optimal decision-making capabilities.

Transplant Carve-Out Programs

Take advantage of exclusive access to multiple transplant networks and enjoy the freedom of choice. Our specially-trained nurses can guide you along
the way.

Plan Members, Family and Caregivers

Patient empowerment delivered! Through tailored education and interventions, we can address patients with complex / chronic conditions and comorbidities, giving them the tools to steer their treatment in the
right direction.

Compassionate Care Meets Innovation

 

Comprehensive State Licensure
Across-the-country service

High-Quality Care
Diligent monitoring and careful evaluation of the appropriateness of care at every level ensures patient satisfaction and improved health

Flexibility
Full customization to meet the needs of any plan

Expectations Exceeded
Record UM response times significantly lower than URAC standards

URAC Accredited Case Management
Registered Nurse Certified Case Managers provide coordination of care across the continuum, maintaining a close connection with the member / family / caregiver(s) along their treatment journey

Disease Management
We specialize in Evidence-Based Guidelines for Diabetes, Asthma, Congestive Heart Failure, Coronary Artery Disease, COPD and Hypertension

Robust Resources
Accessible reporting and secure data portals are available for Stop-Loss Carriers, Plan Administrators
and members

Automated Trigger Diagnosis
Advanced notice of chronic conditions and catastrophic diseases plus referral to CM / DM programs for closer monitoring and care involvement