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- Mission Statement
Nevada Preferred Healthcare Providers (Nevada Preferred), the only Nevada-based, independent statewide PPO network is the result of a partnership between Catholic Healthcare West and Universal Health Services, Inc., who joined their Nevada medical PPO network businesses August 1, 2009. Nevada Preferred now owns and manages the well-known networks of:
Nevada Preferred's Utilization Management (UM) Programs provide clients with expertise about medical necessity for inpatient and outpatient hospital care. Our UM programs combine the expertise of registered nurse reviewers, a board certified medical director and a panel of board certified practicing physicians to help direct patients and providers toward the most cost-effective, quality-driven treatment available.
Nevada Preferred offers two utilization and case management products making every effort to ensure members receive appropriate care in a cost-effective manner. One option is with URAC accredited, American Health Holding. Medical case managers specializing in such conditions as oncology and transplants handle the case management services on a national basis. Another option is made available through Reno-based, NCQA accredited, Saint Mary's Health Plans. Both offer the expertise of registered nurses and medical directors to determine necessity of in-patient and outpatient care and access to quality contracted facilities.
The Case Management (CM) programs for both Utilization Management options provide individuals with access to quality contracted facilities. Services are designed to improve the quality of patient care while maximizing cost savings by providing timely discharge planning, alternative treatment options, and negotiated rate reductions.
Case Managers are licensed registered nurses who are advocates, facilitators, and educators, ensuring that members make smooth transitions from inpatient settings to alternate care and home care when appropriate. Case Managers work with patients and families in tandem with third party administrators (TPAs), insurance companies and reinsurance carriers to provide timely and ongoing information on high-cost cases.