Medical Management

Our team of registered nurses, certified case managers and a medical director has years of experience in healthcare and managed care.

Overseeing and controlling medical costs of claims, MMS staff focus their efforts where they have the greatest impact on health outcomes and preventable spending.

Using predictive analytic modeling, the team identifies members most likely to experience serious and preventable episodes. The staff then collaborates with providers to assess, plan, coordinate and monitor options and services, always with a focus on the individual, striving to provide the highest quality services possible.

Among the services offered by MMS are:

• Precertification when required for any healthcare services
• Disease management focused on improving health outcomes and preventing
  complications
• Case management when members have a serious illness or diagnosis and
  require extensive healthcare services
• Medical bill review and verification, including appeals