Sentinel Utilization Management

 

Focuses on discharge planning and screening for Case Management.

The Sentinel program establishes length of stay using our proprietary, state of the art software.  The focus of the program is placed on discharge planning and screening cases for Case Management.

 

Fast Facts

  • American Health’s Sentinel Utilization Management program is accredited by URAC.
  • The Sentinel Utilization Management program promotes positive relationships with providers and proactively delivers a product in compliance with Department of Labor regulations, Patient Bill of Rights and State regulations related to denial of care.
  • American Health holds licensure in all required states.
  • Case Management triggers flag cases that may benefit from Case Management intervention.
  • Length of Stay is established using national Patient Assigned Stay (PAS) Tables.
  • The service is guided by American Health’s Total Quality Management Program, which sets the highest priority on timeliness, accuracy, quality of care and cost-effectiveness.
  • All nurse reviewers have at least 5-8 years of clinical experience.  They view the best patient outcomes as their goal.
  • The reviewers interact with attending physicians to agree on treatment plans and appropriate lengths of stay.  Cases with a prolonged length of stay are continually monitored throughout the hospital stay to assure quality and appropriateness of care, using established national medical criteria.
  • Detailed and flexible reporting is available to the client.
  • The Sentinel Utilization Management program integrates with American Health’s Case Management, High-risk Disease Management and Care Line (24/7 Demand Management) programs.
  • American Health’s proprietary, state of the art software facilitates all reviews.

Medical Director and Panel of Specialists

Overseeing the Utilization Management program is a Medical Director certified by the American Board of Quality Assurance and Utilization Review Physicians.  The program also offers the expertise of American Health’s own panel of board-certified, practicing physician specialists, in addition to external panels of more than 600 specialists.