Utilization Management
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
This section describes Health Net's utilization management program and processes.
Select any subject below:
- Overview
- Nurse Advise Telephone Triage and Screening Program
- Affiliated Health Plan Delegated Utilization Management - Reporting
- Care Coordination
- Care Management
- Clinical Criteria for Medical Management Decision Making
- Clinical Criteria for Utilization and Care Management Decisions
- Concurrent and Retrospective Review
- Continuity of Care
- Hospital and Inpatient Facility Discharge Planning
- Notification of Hospital Admissions
- Out-of-Area Service
- Prescription Utilization Review
- Prior Authorization
- Separation of Medical Decisions and Financial Concerns
- Utilization Management Program Components