At Innovative Care Management, it is very important to us to constantly ensure that the techniques and methods we use are up-to-date, that decisions being made are correct, and that all steps are being taken to assure that members 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. Our 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. In the interest of providing only the best for the members we serve, the Medical Director helps with services like:

• 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.