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The purpose of the Care Management Department at Community Health Network Of Connecticut is to coordinate, direct and monitor the quality and cost effectiveness of health care resource utilization.  The Utilization Management Program implements comprehensive processes to monitor and control the utilization of health care resources.  Utilization Management assists in ensuring that services are available in a timely manner, provided in appropriate settings, and that services are planned, individualized and evaluated for effectiveness.  Utilization Management also serves to ensure care is safe, accessible and efficient.

Components of the Care Management Department include

  • Referral Management
  • Preadmission review, concurrent review, discharge planning, retrospective review.
  • Case management
  • Verify eligibility, benefits coverage and physician/hospital contract status
  • Identify and route members into specific Disease Management Programs

The Process Improvement Teams will meet quarterly to evaluate current processes and make recommendations for improvements.

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