Today’s ever-changing health care environment creates the challenge to appropriately, efficiently and cost-effectively manage care to achieve quality outcomes.

Contact your ROSE Health Services Consultant for advice, referrals or consultation to enhance your medical case management program — at no cost to you.

• Research information on treatment options, providers and costs
• Identification of claims appropriate for case management
• Recommendations on care alternatives that may be more appropriate and cost-effective
• Methods to evaluate, develop and monitor cost-benefit data to justify medical case management and claims management programs

Business and operations consultation to assist with processes and procedures

• Claim management advisory service
• Operational review and recommendations regarding your internal claims and case management programs
• Recommended procedures to help you in your coverage determinations
• Contract negotiation strategies
• Contract design recommendations

Referrals to our on-line network of independent case managers

When needed, your ROSE consultant can refer you to independent medical case managers in extraordinary circumstances or when special care is needed. (There is no charge for the referral, but the independent case manager will bill you for his/her services.)

Independent case managers can work with your insureds in their hometowns, or with medical emergency admissions when your insureds are away from home (including Canada).

Independent case managers can provide:

• On-site coordination of your insured’s plan of care with the healthcare team
• Assistance with transferring your insureds back into your network facility or to an alternative care site as soon as medically possible
• Support in working with your designated preferred providers and in negotiating costs with vendors and facilities outside your network to gain the most favorable return on your health care dollars

ROSE consultants do not provide medical advice and, of course, any decision as to appropriate medical care must be made by a patient’s health care provider.