Select Circle Utilization Managment
Select
Circle Review plays a pivotal role in maintaining reasonable healthcare
costs for you and your employees. Available either in conjunction with
Select Circle or independently, Select Circle Review is licensed to offer
Utilization Management (UM) services during all phases of care.
COST
SAVINGS and ENHANCED CARE
We integrate ongoing review and case management to ensure
that necessary and appropriate care is rendered. Our panel of knowledgeable
healthcare professionals provides objective oversight and reviews at all
stages: pre-admission, concurrent review, retrospective review and case
management. Evaluations help determine key issues such as appropriateness
of hospital admission, type of service provided, length of stay and discharge
practices. We work closely with employers, patients, providers and third
party administrators in a cooperative effort to ensure responsible, quality
healthcare for your employees.
PROFESSIONAL
OBJECTIVE EVALUATION
Our goal is to provide objective, professional oversight that is fair
to all parties involved. Our UM program is based on the Standardized Medreview
Instrument (SMI) by Systemetrics, Interqual, and further supported by
current formal and informal data.
The Select Circle Review committee is comprised
of:
- six physicians representing a range of disciplines
- a medical director (who also is a practicing
physician)
- a staff of utilization nurses (all RNs).
Our UM manager also is a registered nurse, and our medical director
is a local physician who is available to answer the questions of area
healthcare providers whose cases may be under review.
SELECT CIRCLE
REVIEW SERVICES
Pre-admission Review
Before a patient is admitted to a hospital, the level of medical
necessity is evaluated. Select Circle Review ensures that patients who
require an acute level of care are admitted; when reduced levels of
care are appropriate, then other options -such as outpatient treatment,
home health care, extended care facilities- are recommended. Elective
procedures are also assessed for appropriate level of care, anticipated
course of treatment and, if mandated by the benefit plan, a second opinion
is requested.
Concurrent Review
This ongoing review continues to monitor medical necessity and
appropriateness of care when an employee has been admitted to a hospital
beginning within 24 hours of admission, and continuing throughout the
stay and planning for discharge.
Case Management
This is a more in-depth version of the Concurrent Review, providing
more extensive evaluation of the employees' care as well as direct
involvement in the discharge planning process. Our UM manager partners
with a hospital's Social Service and Nursing Service departments taking
part in case conferences if necessary. Together, they create a discharge
plan that minimizes the hospital stay while anticipating and providing
for appropriate post-discharge care whether at a short-term facility
or through home care based on the patient's condition and prognosis.
Retrospective
Review
In some cases for instance when there is an appeal of a denial
Select Circle Review compiles and analyzes data after care has been
rendered to evaluate the medical necessity and appropriateness of the
services provided.
Select
Circle Review...ensuring responsible, quality
care
To find out more about how Select Circle Review can keep your employees
happy and healthy, contact us at 765-286-3162.
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