Utilization Management — In-House
Stand up an in-house UM program with our reviewers, medical directors, and tooling. We plug into your intake, apply criteria against benefits, and deliver auditable decisions on time.
Evidence-based determinations
InterQual® / MCG alignment with client medical policy, benefits, and regulatory requirements.
Predictable turnaround
Intake-to-decision SLAs with timestamped audit trails and escalation paths.
Letter quality & QA
Member/provider letters with clear rationale, templates, and peer review when required.
Onshore review team
RN reviewers with medical director oversight; specialty routing for complex cases.
<24h
Prior-auth TAT
68%
Auto determinations
15%
Medical cost shift
74%
Appeals resolved 1st pass
Ready to scope your in-house UM?
We’ll align criteria sets, letters, SLAs, and reporting to your policy and benefits.
Contact the Coordinate Team