Utilization Management

Our comprehensive utilization management is a systematic approach to addressing members' behavioral health care needs. Health Plan of Nevada’s Behavioral Health team provides utilization management services, case management, peer support and employee assistance services to the public and private sectors regionally. Currently services are delivered through an extensive, fully licensed and credentialed network of providers that delivers quality care to its patients requiring behavioral health services.

Our comprehensive UM services include:

Prior Authorization and Referral

We're here for our members 24 hours a day, seven days a week. The intake and referral process will provide members with appropriate and individualized care with qualified mental health or substance abuse providers.

Utilization Management

Once members begin receiving care, our case management team will coordinate with the provider to assist in meeting the members' needs. All of our specialty case managers are licensed clinicians who are experienced in dealing with mental health and substance abuse disorders.

Access to Multi-Disciplinary PPO Networks

BHO provides access to multi-disciplinary provider networks. Facilities and providers are credentialed and recredentialed every three years according to NCQA standards. We have existing multi-regional networks and are capable of rapid network development.

Concurrent and Retrospective Review

An experienced care advocate, under the direction of BHO's medical director, is in regular contact with the provider to help ensure the treatment plan meets clinical criteria for the best possible outcomes. This process not only produces consistent excellence in care, but controls costs and provides members with a coordinated plan of health care while creating a collegial relationship with our providers.

Discharge Planning and Continuity of Care

We begin discharge planning at the onset of treatment and it becomes an integral part of the overall treatment plan. Our case managers work hand-in-hand with the treatment providers to deliver individualized treatment plans to the appropriate level of care and clinical services. Regardless of the type of treatment that takes place, an aftercare plan is vital to the success of the patient and the family.

To learn more about our Comprehensive Utilization Management services, please call 1-800-559-9749.