Program Objective
In a field such as medical management, it
is very important to constantly ensure that the techniques
and methods being used are up to date, that decisions being
made are correct, and that all steps are being taken to assure
that patients are receiving appropriate and quality care. It
is precisely for this purpose that Innovative Care Management
includes Medical Director Services in all of our processes.
The Medical Director is a board certified physician who can
provide objective determinations of medical necessity, clinical
oversight, and aid in the development of company procedures
and policies. Innovative Care Management is committed to providing
the highest quality of service in the medical management community,
and with the checks and balances of our Medical Director Services,
we are always on the cutting edge.
Program Description
The Medical Director is an essential component
to all of Innovative Care Management's services, and plays
in active part in our decision making process. In the interest
of providing only the best in medical management, the Medical
Director provides such services as:
-
Medical Necessity Determinations - When a
procedure is complex or questionable, the clinical information
is forwarded to the Medical Director for final determination
to be certain that the review is done with the highest
care and analysis.
-
Denial Determinations - Whenever one
of our nurses believes that a procedure should be
denied for clinical reasons,
the review is forwarded to the Medical Director to
make the determination.
-
Clinical Oversight Committee
- Our Medical Director heads the clinical oversight committee
where we routinely
streamline
our review with the most up-to-date information
in
our decisions.
-
Quality Assurance - As a standard
procedure, the Medical Director reviews a random
selection of procedures
authorized through our Utilization Management and Case Management
departments to verify that consistency is
maintained between the Medical Director and our nurses.
-
Appeals
- When a denied procedure is appealed, the Medical
Director oversees the appeals process, and
reviews any additional information that is provided.
-
New Technology Research
- In cases where new or experimental procedures or technology
are requested,
the Medical Director will research information and determine if it is medically
appropriate and covered under the benefit
plan.
Contact Us
Call Innovative Care Management to ask our sales department
about Medical Director Services or our other programs.
We're here to help you start saving while maintaining the
highest quality care.
General Contact Information:
Innovative Care Management, Inc.
10117 SE Sunnyside Rd., Box F409
Clackamas, OR 97015
Toll Free: 800-862-3338
Portland Area: 503-654-9447
Fax: 503-654-8570
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