Vale-U-Health - Care and Utilization Management Services

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.