What We Do

Novus 360 Utilization Management

Novus 360 Utilization Management

Helping You Deliver Smarter, More Effective Care

Novus 360 is our comprehensive Utilization Management solution designed to ensure your members get the care they need—without unnecessary tests or inflated costs. We focus on streamlining the delivery of quality care, backed by best practices and real-time clinical insights.

What You Gain with Novus 360

Quality Assurance
We align medical services with clinical guidelines, ensuring every treatment meets rigorous standards of care.
Cost Containment
Our approach minimizes redundant tests, procedures, and hospitalizations—helping control healthcare costs without compromising quality.
Better Patient Outcomes
With evidence-based care at the core, we help boost health outcomes and patient satisfaction across the board.

Explore the Process

Core Processes

Preauthorization
Verifies medical necessity before certain treatments, avoiding unnecessary interventions.

Concurrent Review
Monitors patient care in real time to ensure ongoing appropriateness and effectiveness.

Retrospective Review
Assesses care after it's delivered to evaluate quality and uncover areas for improvement.

Case Management
Coordinates care for patients with chronic or complex conditions, improving outcomes and controlling costs.

Who's Involved in Utilization Management

Healthcare Providers
Doctors, nurses, and clinicians ensure treatments align with medical guidelines.

Insurance Companies
Payers set UM protocols to manage risk and control healthcare spending.

Patients
Receive care tailored to their needs—avoiding overtreatment and unnecessary procedures.

Utilization Review Organizations (UROs)
Support providers and payers with expert oversight and objective clinical reviews.

Benefits of Our Approach

Smart Resource Use
We make sure healthcare assets are directed where they're needed most.

Clear, Accountable Care
A structured process brings transparency to care decisions and builds trust.

Fewer Medical Errors
Standardized practices reduce risks and ensure safer, more effective treatment.

Comprehensive Healthcare Systems Inc.

Learn More

Learn More

Want to dive deeper into how Utilization Management supports better care? Explore our focus areas below.

Prior Authorization
Confirms the need for specific procedures before care begins.

Medical Necessity
Ensures treatments are clinically justified and appropriate.

Care Management
Coordinates services for complex cases, improving care continuity.