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Utilization Management

The first line of defense to manage healthcare costs.

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Over 20 years of experience providing Utilization Management services to complex populations

Kepro’s Utilization Management (UM) program promotes quality and cost-effective healthcare and member well-being that ensures appropriate utilization of services. We currently provide UM in eight states and bring broad knowledge and industry-best practices to maximize quality care and cost-effective outcomes across the continuum of care.

Kepro's decades of UM experience with proven outcomes are evidence of our ability to support and ensure our client’s initiatives are advanced and positive outcomes are created for their members. Our solution is tailored to provide intelligent value by leveraging our clinicians and national expert resources.


Our URAC accredited Utilization Management solution includes: 

  • Prior authorization of inpatient and outpatient services
  • Surgical procedures and transplants
  • Behavioral health services
  • Extended outpatient therapies
  • Radiology services
  • Durable medical equipment
  • Retrospective review
  • Prior authorization for organ/ tissue transplants and nursing services
  • Concurrent review
  • Discharge planning and care management program referral
  • First and second level appeals

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Our 360-Degree Approach to Care Management

Utilization Management

Providing the right patients with the right care in the right setting — every time.

Case Management

Identifying and improving outcomes for high-risk, high-cost beneficiaries.

Care Coordination

Leveraging cross-disciplinary insights to create a full-scope view of patient health.

Pharmacy Management

Increasing pharmacy efficiency, accountability and compliance with expert guidance.

Employee Assistance Program

Supporting employee wellness and productivity with comprehensive services.

Absence Management

Tracking and analyzing employee absences to identify trends and opportunities.

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