Case Management & Utilization Review

Ensure medical necessity. Reduce denials. Keep patient flow moving.

The Challenge

UR Gaps Lead to Denials, Overstays, and Lost Revenue

Hospitals are under pressure to manage length of stay, meet InterQual or MCG criteria, and support compliance without burning out staff. But staffing shortages, inconsistent reviews, and lack of audit readiness can quickly derail performance.

Common issues include:

Missed or delayed medical necessity reviews
Gaps in documentation for inpatient admissions
Unmanaged length-of-stay issues
Revenue leakage from denied or delayed claims
Inadequate coverage for ED case management or pre-certification

OUR SOLUTION

Flexible, Credentialed UR Support When You Need It

HIP deploys experienced, CCM-credentialed nurses to support Utilization Review and Case Management functions remotely or onsite. Whether short-term coverage or long-term staffing, we help hospitals stay compliant, efficient, and prepared.

We offer:

Initial, concurrent, and retrospective reviews
Emergency department and pre-certification support
Focused audits: One-Day Stay, Two Midnight Rule, Inpatient vs Observation
Inter-Rater Reliability audits
LOS assessments and process evaluations
Staff education (InterQual / MCG)
Remote and hybrid delivery options

HOW IT WORKS

How We Strengthen UR Teams

Assess. Cover. Improve.

Define Your Needs
We identify gaps in coverage, review turnaround, or audit exposure – fast.
Deploy Skilled Nurses
Our licensed, experienced staff integrate seamlessly with your workflows and systems.
Run Focused Audits
We evaluate documentation and medical necessity to prevent denials and recoup missed revenue.
Train and Educate
We deliver targeted staff training and tools to maintain standards and reduce overreliance on temp labor.

Why Choose HIP for Utilization Review

HIP is your healthcare operations partner. Our UR professionals bring deep clinical experience, regulatory knowledge, and EMR fluency to every assignment.

100% U.S. Based

No offshoring. All staff reside and work in the U.S.

AHIMA/AAPC

Every coder holds active credentials.

Proven Professionals

10 years of experience on average

Rapid Deployment

Get support mobilized in days, not weeks.

No Contracts

Flexible engagements with no minimum volume.

Monthly QA Reviews

Ongoing audits for accuracy and compliance.

Strict Vetting

Drug tests, credential verification, etc.

Direct Oversight

Projects led by experienced managers, not freelancers.

Stay Informed

Our quarterly newsletters share timely insights across all service lines - including regulatory updates, reimbursement trends, documentation best practices, and compliance strategies.

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Fill the Gaps in Your UR Coverage

Get experienced utilization reviewers and case managers when and where you need them.

Get UR Support