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Utilization Review
Coventry’s URAC and state-certified Utilization Review service provides prospective, concurrent and retrospective review of the medical necessity of services requested. Registered nurses complete first level reviews based on national, evidence-based guidelines, and coordinate reviews with our expert Physician Advisors when such guidelines are exceeded or unmet. Registered nurses perform both Utilization Review and Telephonic Case Management as regulations permit, providing a seamless and efficient process to facilitate timely and appropriate treatment.
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Field Case Management
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