Services
Allegiance Care Management
Utilization Management
Care Management’s URAC accredited Utilization Management program provides medical necessity reviews of both hospital admissions and outpatient services to determine the medical necessity, requested-setting, level of care and quality of care of the requested service. The team reviews the member’s medical history and assesses the proposed care for appropriateness.
Our detailed review and the use of evidence-based care criteria, promotes cost savings by evaluating the appropriateness, medical need and efficiency of healthcare services, procedures and facilities. Each review is also treated as an opportunity to identify high-risk individuals who may benefit from case management.
Case Management
Case Management identifies high risk individuals who would benefit from complex case management services. Each identified individual is assigned a Case Manager who develops a customized member care plan and establishes care goals along with the member. This results in positive member outcomes, improvement of navigation of the healthcare system, and mitigation of healthcare costs.
Allegiance Case Management’s program oversees a member’s complex, acute and catastrophic conditions to assess an individual’s needs and facilitate long-term treatment to eliminate or mitigate acute episodes. Through early intervention and intensive case management Allegiance is able to effectively coordinate and manage your groups’ most medically challenging cases.
Each personal nurse case manager develops a care plan that incorporates creative approaches utilizing appropriate, cost-effective care. Our trained professionals identify at-risk individuals who would benefit from case management or other supportive services. The Allegiance Care Management’s approach is one of partnership with the member, family, provider, facility, and Plan Sponsor.
Specialized Case Management
Our Care Management Program incorporates specialized case management. Our dedicated registered case management nurses work one-on-one with their members and the providers to coordinate care in several areas including: oncology care, high risk maternity, NICU, end stage renal disease, and transplants. Each specialized nurse ensures appropriateness of treatment that meet evidence based guidelines, and provides expert education and support to assist member with their care.
Allegiance Care Management Maternity Management
Maternity Management offers pregnancy related information and support from a personal Nurse Case Manager that is available to talk with the member throughout their pregnancy. The Nurse Case Manager will perform a maternity risk assessment to identify possible risks or needs.
Early intervention and education can mitigate costs associated with high-risk pregnancies
Site of Care
The Allegiance Site of Care (SOC) optimization strategy is used to reduce the cost of specialty biologic medications. Through our SOC program, Allegiance seeks to lower costs associated with certain infused or injected drugs by encouraging the use of clinically appropriate, lower-cost care settings. SOC optimization encourages members to transition from high-cost settings to a lower-cost setting such as stand-alone infusion suite or home. These alternative options maintain high quality standards while being more affordable and accessible in comparison to hospitals.
The Site of Care program combined with Plan language that encourages member participation can lead to even greater savings over time while still ensuring that members receive the appropriate treatment as well as the most beneficial outcome of care for members.