AREAS OF EXPERTISE
Tap into unparalleled industry experience & support.
Our managed care experts roll up their sleeves and work alongside you to address hurdles you’re facing in medical management and beyond. From advisory services to full teams, we’re here to help.
OUR EXPERTISE
Solutions for medical, behavioral and specialty benefits for all lines of business.
Med & BH Utilization Management
The right care, in the right setting, at the right time.
Specialty UM
Pre-authorization expertise for substance use disorder, ABA Management/Autism Spectrum Disorder, MLTSS, IEP and more.
Physician Review Services
Expert multi-state-licensed physician reviewers.
Appeals & Grievances
Physicians, nurses and best practices for A&G
Care Management
Med & BH Case Management
Med, BH and integrated approaches to acute and complex cases.
Model of Care (D, C, I-SNP)
Care coordination, provider network, quality measurement for all SNP types (D, C, I)
Med-Psych Care Management
Positive impact on physical and behavioral health costs and outcomes through a proprietary interventional approach delivered on your platform.
Specialty Care Management
Specialty expertise for substance use disorder, ABA Management/Autism Spectrum Disorder, MLTSS, IEP and others.
Population Health
Tailored support in identification, engagement and intervention for your population health programs.
“Toney Healthcare’s background in the health services corridor is important. I don't need to spend hours educating Toney on what we do as a business.”
- Health Plan Executive
Accreditation
Gold standard accreditation support in readiness assessment, planning, preparation and submission for both initial and renewal accreditation.
Quality
Best practices and support in Quality Improvement initiatives and measurement for HEDIS, Stars and state-required and internal measures.
Regulatory & Compliance
Excellence in monitoring, audits, corrective actions and reporting to maintain compliance across all governing bodies.
The Toney Healthcare teams have in-field experience in all areas of medical management.
“I received a referral from our UM VP who had used Toney Healthcare in the past. It was a very quick process to get started with Toney Healthcare. It has been a smooth process with great staff and an overall wonderful experience. I would highly recommend!”
– Health Plan Executive
WAYS TO ENGAGE
Discover the right solution for your health plan.
From designing a program, to filling gaps in staff, to providing a full medical management team, we’re here to help with flexible service models.
