Medical Management

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.

Utilization Management

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.

Learn how to connect members to appropriate care at affordable cost

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.

Learn how MagnaCare helps contain costs, not 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.

Learn more on guiding members to their best health

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.

Learn more about how we help members achieve their health goals

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.

Learn more about how we help reduce opioid use among your members

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.

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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

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Price transparency tool

With a quick, search in our price transparency tool, members can find pricing information
related to symptoms, conditions, and procedures.

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