Case management interim and consulting solutions that support physicians and health plans with managing cost of care across the continuum
Increasing competition within the provider and payer markets along with the shift towards value-based care forces healthcare entities to prioritize all aspects of care coordination. Regulation support and technology advancements are driving the growth of retail clinics and enabling care in lower acuity settings. In order to avoid denials and penalties for readmission, patients that are admitted must have proper authorization and documentation to support the care needed.
Harmony Healthcare provides case management and utilization review interim and consulting solutions that support physicians and health plans with properly managing the cost of care across the continuum.
Our solutions will help you:
- Provide optimum quality of care
- Manage continuity and transition of care efficiently
- Reduce readmission risks
- Eliminate avoidable days
- Enhance claims management and clean claims
- Improve organizational performance
Our case management solution provides expertise in:
- Comprehensive and holistic patient assessment.
- Facilitation of discharge transition to the appropriate level of service.
- Alignment and coordination of post-discharge needs with the physician treatment plan and within the patient benefit structure.
- Development, implementation, and ongoing monitoring of an individualized plan of care.
- Licensed social work staffing.
Our utilization review solution provides expertise in:
- Medical necessity reviews.
- HEDIS solutions.
- Prior authorization, concurrent, and retrospective reviews.
- Documentation and tracking of peer-to-peer conversations, reconsideration reviews, and multi-level appeal processes.
We place professionals such as:
- Case Management Director, Manager / Supervisor
- Case Manager
- Utilization Review Nurse / Specialist
- Social Worker
- Patient Care Coordinator
- Discharge Planner