AdvoCare’s Utilization Management program is designed to manage healthcare costs by reviewing medical services for necessity, appropriateness, and efficiency to ensure that a patient receives the right level of care. Our program reduces the number of unnecessary or inappropriate healthcare services by approving admissions and procedures, determining length of stay, and conducting discharge verification. AdvoCare has the ability to customize services required for authorization based on the client’s individual benefit plan.

AdvoCare’s Case Management program utilizes registered nurses who focus on those cases requiring an additional level of management based on complexity, severity, and chronicity. The case managers make the healthcare system work for both the patient and the client by influencing and managing quality, cost, satisfaction, and optimal health status across all healthcare settings. The nurse case manager works in partnership with the patient and their family, the physician, and the claims payer/TPA to facilitate and coordinate appropriate care and services as well as patient-centered approaches to education self care management.

Our Maternity Management Program is an early identification and intervention program that assists mothers and babies in having a healthy start with pregnancies, births, and newborn care.