Efficient Utilization Management helps control healthcare costs and provides the right level of care for Members.  Technology can be efficiently leveraged to support daily operations such as Authorization Entry, Clinical Review by Nurses/Medical Directors, Concurrent and Peer-2-Peer Review functions. Technology must be configured to align with standard operating processes and workflows to ensure compliance with regulatory requirements for Turn-around time (TATs), reduce audit and penalty risks. Optimal utilization management is vital to overall cost management, Member support of basic Insurance functions and overall Payer performance. With a wealth of experience and deep expertise in utilization management, Yzarc Consulting is your trusted partner in optimizing Utilization Management processes, workflows and solutions.

Yzarc Consulting offers a comprehensive range of capabilities to support your Utilization Management needs:

•  Assist with modifications and enhancements to your authorization solution, aligning it with your business standard operating procedures (SOPs) and regulatory requirements. 

• Build efficiency in authorization entry through user-friendly provider self-service functions

• Enable Providers to easily view authorizations throughout their entire lifecycle, ensuring transparency and historical data accessibility. 

• Establish optimal workflows/SOPs for clinical and Medical Director authorization reviews

• Design authorization letters 

• Assist with improvements in the submission of authorizations for seamless claims processing. 

• Support Reporting for daily operations, track turn-around time (TAT), etc. 

At Yzarc Consulting, we recognize the critical importance of care management in achieving successful outcomes for complex health at risk populations. 

Care coordination with clinical integrated tools, clinical guidelines and core 360 Degree view of a Member are foundational components for achieving success. Enabling sophisticated population and care analytics that support value-based incentives is vital to be competitive in the Payer arena.   The smartest way to care for complex individuals is to address the whole person, including the behavioral and social determinants that prevent even the best medical care from being effective. Ultimately, you’ll improve care team effectiveness and financial results while delivering better outcomes for individuals and populations. A 360 degree view of Members is necessary to support comprehensive Care Management. Members must be supported through the Continuum of Care consisting of Wellness/Illness prevention, Acute or Chronic Medical needs, Behavioral issues, and Community-based programs. Payers must integrate their vital data and systems to support members through the Continuum of Care in order to deliver consistent, informed, value based care.