Utilization Management
The Utilization Management Department is responsible for establishing and monitoring all clinical services provided by CBHM. Through the UM Committee structure the CBHM Medical Director, Vice-President of Clinical Service, Director of Intensive Services, and Director of Care Management monitor for compliance of all approved targets and standards including:

• Access & Referral
• Post Discharge Follow Up Appointments
• Denials and Appeals
• Continuity of Care Authorizations
• Primary Care Coordination
• Utilization Trends
• Case Management Review Timeliness

Case Management is one of the major activities of the Utilization Management Department. All case management services for ambulatory and inpatient services are provided by licensed staff, in accordance with approved clinical guidelines. Level of care and medical necessity criteria are part of the case management function while quality of care remains a primary focus. Case Management services include:

• Outpatient/Ambulatory Concurrent Review
• Continuity of Care
• Primary Care Coordination
• Inpatient Review
• Physician to Physician Review
• Intensive Case Management
• Identification of High Risk Populations
• Denials and Appeals
• Provider Education & Training