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Medical Management

Medical management is an integral component of any comprehensive health care plan and is the key to success in effectively management outcomes and cost. Our experienced medical management professionals collaborate with our providers to ensure appropriate levels of care and increased patient satisfaction.

PPHN Delivers Quality
Through our network of member PPOs, PPHN provides a full array of utilization and medical management services, allowing you to optimize your health care resources effectively. All of our services are provided by certified Utilization Management (UM) organizations. Conducting monthly meetings to review policies and procedures allows us to maintain the high standards set by the URAC compliant process of reporting and analyzing. What does that mean for you? Quality all around.

Focusing On The Patient
One of our case manager's best describes her role as a "patient advocate that is here to help them navigate the health care system, as well as help their physical and emotional well being." When someone is dealing with the stress of health problems, having someone who can better interpret medical terms and help them receive the best care possible is our goal. Our five medical directors oversee the local departments and have extensive professional experience in the related fields they are managing.

Services Designed With Patient Care And Cost Management In Mind
Our complete service offerings include:
   • Pre-Notification and Pre-Certification of Services
   • Inpatient Utilization & Concurrent Review
   • Discharge Planning
   • Out-of Network Referral Management and Negotiations
   • Case Management Services
   • Centers of Excellence
   • Clinical Consulting on Plan Design

Containing medical costs while providing the highest level of quality care and patient satisfaction. That's how we deliver on our commitment to provide the most efficient health network solutions that benefit your employees and your bottom line.