Flexible Support for Essential Health Plan Operations
When your organization needs additional capacity or focused clinical expertise, TotalMed can support individual workflows or fully managed functions. Explore seven service areas designed around the day-to-day needs of health plans and their members.
Choose The Support Your Team Needs
Each service can help add capacity, specialized expertise, or focused member support. Select a service to learn more about its scope and capabilities.
Utilization Management Outsourcing
Extend your clinical review capacity with experienced nurses and reviewers who support timely, consistent decisions.
Prior authorization
Concurrent review
Medical necessity review
Appeals & Grievance Outsourcing
Add focused support for member and provider cases while keeping documentation and turnaround requirements in view.
Member appeals
Provider appeals
Grievance support
Physician Review Services
Connect with board-certified physician reviewers for independent clinical insight and case-level support.
- Medical necessity review
- Peer-to-peer review
- Clinical consultation
Extend your clinical review capacity with experienced nurses and reviewers who support timely, consistent decisions.
Prior authorization
Concurrent review
Medical necessity review
Care Management Outsourcing
Expand member support with clinical professionals focused on coordinated, practical care management.
- Complex case management
- Chronic disease support
- Transitional care
Add focused support for member and provider cases while keeping documentation and turnaround requirements in view.
Member appeals
Provider appeals
Grievance support
Health Risk Assessment Services
Support outreach, assessment completion, and clinical documentation to help identify member needs.
Member outreach
Health risk assessments
Risk stratification
Care Gap Closure Services
Strengthen quality initiatives through focused member outreach, education, and preventive-care support.
- Quality measure support
- Member education
- Preventive care outreach
Clinical Call Center Services
Build responsive clinical contact-center capacity for members who need guidance, coordination, and support.
- Nurse advice lines
- Clinical triage
- Care coordination