Quantum Health Complete™ navigation solution offers clinical expertise that is integrated into its medical journey navigation system. One of the key components of the solution is the pairing of members with a nurse from Quantum Health’s in-house team. These nurses offer guidance and support to employees throughout their medical journey, from explaining complex diagnoses to checking on the emotional wellbeing of their families.

The nurses are trained to provide decision support, needs assessments, care plans, and relief that are tailored to each member’s unique needs. Additionally, the solution offers various medical management services, such as utilization management, high-cost case review, medical appeals coordination, case and disease management, preadmission and post-discharge planning, behavioral and mental health support, prescription and specialty pharmacy management, transplant and oncology management, referral, and eligibility verification for providers.

The utilization management service ensures that the appropriate level of medical care is provided to members, while the high-cost case review assists in identifying and managing high-cost cases to ensure quality care is delivered. The medical appeals coordination service helps members navigate the appeals process in the event of denied claims. Case and disease management helps members manage their health conditions and navigate the healthcare system.

Preadmission and postdischarge planning services help members prepare for hospitalization and ensure a smooth transition back home. Behavioral and mental health support provides members with access to licensed behavioral health professionals who can assist with mental health issues. The prescription and specialty pharmacy management service ensures that members receive the appropriate medications and have access to specialty pharmacies. Finally, the referral and eligibility verification service assists members in finding providers that are within their network and eligible for their coverage.

Overall, Quantum Health Complete™ navigation solution provides comprehensive clinical expertise and support services that help members navigate the complex healthcare system. The solution offers a high level of personalized care that is tailored to meet each member’s unique needs, helping them achieve the best possible health outcomes.

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