Utilization Review for Rhode Island Medicaid Recipients
Utilization Review for Rhode Island Medicaid Recipients Nancy Kelly
Performs utilization review services for Rhode Island fee-for-service Medicaid recipients.
Unnecessary healthcare procedures, ineffective treatments and overlong hospitals stays are a few examples that lead to an overburdened health system and dissatisfied patients.
Under contract with the Rhode Island Department of Human Services, Qualidigm performs utilization review services for Rhode Island fee-for-service Medicaid recipients. Our team of case managers evaluate the medical necessity, appropriateness and efficiency of the use of health care services, procedures in acute care hospitals, free-standing psychiatric and rehabilitation hospitals, and a hospital with a NICU.
Qualidigm’s high quality case management has resulted in decreased hospitalizations with a total savings of over $5.4M in four years.