Utilization Management
The Right Care at the Right Time
Medical treatment consistent with evidence-based practice.
Compliance
Why Does Accreditation Matter?
Without accredited utilization review, treatment decisions lack the rigor and transparency needed to withstand regulatory scrutiny. Late decisions, isolated automation, and opaque processes put your organization at risk.
Late decisions from missed compliance Isolated code automation Confusion from lack of transparency 
Utilization Management
The Simplicity of Utilization Review
Our utilization review process ensures that every treatment request is evaluated against evidence-based guidelines by certified practitioners, giving you clear, defensible decisions on time.
Certified Practitioners
Every review is conducted by licensed, certified clinical professionals who understand both the medical and regulatory landscape.
Stop Unnecessary Expenses
Identify and prevent excessive or inappropriate treatment before costs spiral out of control, without compromising patient care.
Evidence-Based Guidelines
Decisions are grounded in nationally recognized treatment guidelines, ensuring consistency, defensibility, and optimal outcomes.
UR Services
Comprehensive Review Services
From pre-certification to expedited review, we handle every type of utilization review with speed and accuracy.
Pre Certification- Pre Authorization
- Prospective Review
- Retrospective Review
- Physician / Peer Review
- Concurrent Review
- Expedited Review
Look at What Our Customers Are Saying
"Ethos UR decisions are timely, well-documented, and defensible. Their team understands the balance between cost control and appropriate care."
"The transparency of their UR process has eliminated confusion for both our adjusters and the treating providers. Everyone knows where things stand."
"Since implementing Ethos utilization management, we've seen a measurable reduction in unnecessary treatment costs without any increase in disputes."
Get Started in 3 Easy Steps
Talk to Us
Discuss your utilization review needs and current challenges. We'll build a program tailored to your compliance requirements.
Begin Proactive Management
Our certified practitioners begin reviewing treatment requests against evidence-based guidelines within your required timeframes.
Get Your Report Back
Receive clear, documented decisions with clinical rationale that you can share with all parties involved in the claim.
Frequently Asked Questions
What is Utilization Review?
Utilization Review (UR) is a process used to evaluate the medical necessity, appropriateness, and efficiency of healthcare services prescribed to injured workers. It ensures that treatment aligns with evidence-based guidelines and regulatory requirements.
Can Utilization Review be used in all states?
UR is available in most states, though specific regulations, timelines, and requirements vary by jurisdiction. Our team is knowledgeable in state-specific UR mandates and ensures compliance with each state's unique rules.
Can treatment be managed through Utilization Review?
Yes. UR allows payers to proactively manage treatment by certifying appropriate care, modifying requests that exceed guidelines, and denying services that are not medically necessary. This helps control costs while ensuring injured workers receive proper care.
Is Utilization Review the same as Peer Review?
No. Utilization Review is typically performed by licensed nurses or clinical staff using evidence-based guidelines. Peer Review involves a physician of the same or similar specialty reviewing the medical necessity of treatment. Peer Review is often the next step when a UR determination is disputed or when physician-level expertise is required.
Don't Get Stuck Paying More
Unnecessary treatment drives up costs and delays recovery. Take control with evidence-based utilization management that keeps claims on track.