How Our Utilization Management Works


At Global Clinical Services, our utilization management offering helps health plans and provider organizations make confident decisions about care delivery. We focus on making sure each request for treatment is reviewed carefully and fairly so that the care ultimately delivered matches clinical standards and patient needs.

Step 1: Evidence-Based Review of Proposed Services

We begin by evaluating proposed services against established criteria and evidence-based care guidelines. This process helps ensure that the care recommended is medically appropriate and aligns with the benefit plan. As part of that evaluation, we also verify eligibility and benefit coverage so the patient’s plan supports the service before it moves forward.

Step 2: Coordination of Approved Care

Once care is approved, we support coordination of logistics, including scheduling, transportation if needed and discharge planning when a facility stay is involved. With this coordinated approach, patients avoid delays, and providers can deliver the right level of care in the right setting.

Step 3: Ongoing Review and Optimization

Beyond initial review and coordination, our utilization management team remains engaged. We monitor ongoing services for appropriateness and intervene when changes are needed. We help identify when a less-intensive or alternative level of care would meet the patient’s needs while maintaining safety and quality. This ongoing review helps prevent unnecessary utilization and supports better outcomes.

Key Benefits of Our Services

  • From a Provider Perspective:

    Utilization Management reduces administrative burden and improves the predictability of care flow. Providers and health plans benefit from streamlined processes and clear communication about what is covered, what is needed and how to proceed. That clarity helps reduce waste and optimize resource use.

  • From a Member's Perspective:

    The process offers transparency and support.
    Patients and families receive clear explanations of service decisions and benefit eligibility. They gain support in navigating care approvals and coordination so that they can focus their energy on recovery and wellness rather than on paperwork and uncertainty.