Utilization Management (UM) Program

Alliance’s UM program works to make sure our members and recipients get the best care while making sure resources are not wasted.  To do this, they review data and work closely with providers to make sure member and recipient needs are being met.

The main goal of the UM program is to make sure members and recipients are getting high-quality care and that providers have the support and resources they need. Other goals of the UM program are to:

• Help physical and behavioral health providers work together to provide whole-person care
• Make sure care and services are given in a way that aligns with members’ beliefs, behaviors, practices, abilities and language
• Follow all local, state, and federal requirements
• Create unbiased and evidenced-based plans and rules to support clinical decision making
• Analyze claims and data to find over, under and misuse of resources
• Improve relationships with providers through Alliance staff involvement and peer-to-peer conversations
• Protect the personal health information of all members and follow all Health Insurance Portability and Accountability Act (HIPAA) regulations

If you want to learn more, you can see the full UM Program description below.