First Step has developed an operating process for utilization management designed to authorize and monitor the provision of counseling care to the eligible client in need of services.
Utilization management includes the process of managing the delivery of service to ensure that clinically effective and cost efficient care is provided to clients; that decisions are made in a fair, impartial, and consistent manner in the best interests of client, based on their individual needs.
The underlying principle is provision of the right service, at the right time, for the right duration in the most cost effective manner possible.
The objectives of utilazation management are:
> To ensure the provision of consistent, clinically appropriate and cost efficient service for the person receiving counseling service.
> To ensure compliance with requirements of state and deferal regulatory agencies that monitor utilization review programs.
> To ensure consistent and timely notification to all clients and providers of record of authorization denial determinations and afford opportunities to appeal with the least interruption of services possible.
> To obtain and summarize aggregate data and idetify trends and patterns that are reported to the Local and State Authority for use in planning and provision of quality services.