Claims 2020 │Utilization Review

Utilization review is a proven approach for ensuring workers comp patients, private health plan members and public health insureds receive effective medical care. Using evidence-based protocols, UR program clinicians review treatment and pharmacy requests for medical necessity, maximizing the quality and cost efficiency of healthcare services.

Despite the benefits that UR provides, not all programs are created equal. There is still significant opportunity to expand its use and impact on claim outcomes. Join our workers compensation, private healthcare payer, and government healthcare payer experts as they examine the evolving role of UR and share their perspectives for making UR more efficient and effective.

What You’ll Learn

• Why UR is playing an expanding role in medical management strategy
• New technology and automation for increasing the efficiency and consistency of reviews
• How predictive analytics applied to claims data can help you identify red flags
• How to apply an evidence-based approach to improve performance

Speakers

JJ Schmidt
Solutions Consultant
JJ is a managed care and insurance claims solutions expert focused on strategy, process and information technology for the Property and Casualty (P&C) Insurance market.

 

Carol Valentic, BSN
Senior Director, Commercial Healthcare Delivery
Carol oversees delivery for Conduent’s Commercial Healthcare solutions, including medical bill review outsourced service, as well as medical management and clinical review services.

 

Janelle Sheen, Pharm.D.
Director, Clinical Services, Government Healthcare Solutions
Janelle is a residency trained Pharm.D. with clinical experience in managed care and pharmacy benefits management. She is Conduent’s subject matter expert in drug utilization review (DUR) solutions.

 

Michael Sauls
Portfolio Executive, Healthcare Payer Solutions
Michael is responsible for operational and strategic planning for Conduent’s healthcare payer solutions business, which focuses on optimizing value and outcomes for health plans and their members.