In a field such as medical management, it is very important to constantly ensure that our members’ care is never compromised. It is our role to assure that the care proposed is appropriate, timely, and covered by the plan we are working for. It is precisely for this purpose that Innovative Care Management includes Medical Director Services as an adjunct to all of our programs. ICM’s Medical Director is a board certified physician who can provide objective determinations of medical necessity, clinical oversight, and frequently assists in the development of our clients’ plan wording and policies.
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.
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 reviews with the most up-to-date information in our decisions.
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.
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.