MagnaCare’s Medical Management team focuses on providing our members with the best care at the lowest cost.
It oversees the quality of care while ensuring appropriate utilization of medical services. Our goal is to provide patients with the best possible care based on medical necessity, while eliminating repetitive, unnecessary services.
We determine that services are medically appropriate and necessary through the use of evidence-based clinical guidelines, benefit tiering, and prior authorization. Through our navigation program, we monitor claim activity to identify recurring or expensive claims to support redirection of services that improve the quality of care and reduce costs.
Cost Containment Services
We perform high-quality clinical claim reviews to validate claims and identify opportunities to recode claims to deliver costs savings
to our clients. Plus, our experienced nurses apply their clinical
knowledge to assess medical necessity, level of services and
appropriateness of care according to policies and accepted medical standards of care.
Population Health Management
We coach your members through chronic and complex health
issues, support them on their path to health and wellness, and
guide them through the unexpected health issues that can arise.
Our team will spend time with your members to develop
personalized plans that bring down barriers between them and
the care they need.
Case Management Programs
Highly trained nurse counselors proactively reach out to members who have complex and catastrophic medical conditions and who
would benefit from individualized case management. The program achieves healthier, happier members, and lower medical expenditures.
Nurse Triage Line
From the comfort of their own home, members can access clinical support 24/7/365. An after-hours nurse triage line uses HIPAA-compliant software systems to help members identify the appropriate level of care needed at that time for the symptoms presented.
Replacing the traditional face-to-face doctor visit, telemedicine is a virtual office visit in the convenience of the member’s home, where a doctor diagnoses the condition and prescribes
Price transparency tool
With a quick, search in our price transparency tool, members can find pricing information
related to symptoms, conditions, and procedures.
Pain Management and Opioid Oversight Program
Using prior authorization, tapering plans, and tailored case management, our Pain Management and Opioid Oversight Program prevents addiction and weans persistent users from opioids. In collaboration with your Pharmacy Benefits Manager (PBM) and workers’ compensation insurer, we address concerns regarding formulary and implement communication workflows, data access and collection.