Jump to content

  • Set Your Location
  • Sign in or Enroll
Set Your LocationSutter Medical Foundation
  • Sign in or Enroll
    • Open I want to choose my medical group or hospital
    • Clear my location
Change Location
Sutter Health
  • Video Visits
  • Find Doctors
  • Find Locations
  • Treatments & Services
    • Video Visits
    • Find Doctors
    • Find Locations
    • Treatments & Services
    • COVID-19 Resources
    • Pay a Bill
    • Symptom Checker
    • Get Care Today
    • Health & Wellness
    • Classes & Events
    • Research & Clinical Trials
    • For Patients
    • About Sutter Health
    • Giving
    • Volunteering
    • Careers
    • News
    • For Medical Professionals
    • Other Business Services
Close Search
  • Home
  • Sutter Medical Foundation
  • For Patients
  • Coordination of Care
Content

Case Management

Utilization Management Services

Sutter Health Sutter Valley Medical Foundation's Continuum Case Management provides utilization management services for Health Maintenance Organizations (HMO) health plans contracted with Sutter Independent Physicians and Sutter Medical Group and Sutter Gould Medical Group.

Sutter’s utilization management services are designed to monitor, evaluate, and manage the cost and quality of health care services delivered to all patients of Sutter Independent Physicians and Sutter Medical Group. Sutter utilization management performs prospective, concurrent, and retrospective review of services requested by health care providers using nationally accepted criteria and informational resources to determine the appropriateness of healthcare services.

All practitioners, providers, and utilization management staff involved in decision making processes are required to sign affirmation statements regarding confidentiality and incentives. The statement acknowledges the following for utilization management decision makers:

  • Utilization management decision-making is based only on appropriateness of care and service and existence of coverage.
  • The utilization management organization does not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service care.
  • Financial incentives for utilization management decision makers do not encourage decisions that result in under utilization.
  • Reviewers are ensured independence and impartiality in making referral decision that do not influence:
    • Hiring
    • Compensation
    • Termination
    • Promotion
    • Any other similar matters

Sutter Case Management undergoes annual HMO Utilization Management oversight audits to ensure compliance with state and federal regulatory requirements.

Practitioners, providers, members, or member's representatives can contact Sutter Case Management staff Monday through Friday from 8:00 am to 5:00 pm at (916) 649-4100 or toll free through customer service at (888) 516-8023 to inquire about utilization management processes, affirmative statements, or criteria/guidelines. For assistive listening systems, Sacramento Division, call NorCal Center for Deafness at (916) 349-7500; for Relay Service, Sacramento Division, call 711; for Speech to Speech, Sacramento Division, call 711 and ask for Speech to Speech.

Advanced Illness Management (AIM)

At Sutter Health, we've seen how the right support can help patients with advanced chronic illnesses live the kind of life they want. When given skilled, respectful coaching and care, patients can better manage their health.

That's why we created Advanced Illness Management (AIM), a program that partners with your doctors to provide you with the nursing and other support you need to manage your illness and live your life.

To learn more about the AIM program and how it can help you or your loved one, please call (877) 775-7728.

The Sutter Health Network of Care
Expertise to fit your needs
Primary Care

Check-ups, screenings and sick visits for adults and children.

Specialty Care

Expertise and advanced technologies in all areas of medicine.

Emergency Care

For serious accidents, injuries and conditions that require immediate medical care.

Urgent Care

After-hours, weekend and holiday services.

Walk-In Care

Convenient walk-in care clinics for your non-urgent health needs.

  • Contact Us
  • Find Doctors
  • Find Locations
  • Request Medical Records
  • Make a Gift
Sign in to My Health Online

Billing and Insurance

  • Pay a Bill
  • Accepted Health Plans
  • Estimate Costs
  • Medicare Advantage

About Sutter

  • About Our Network
  • Community Benefit
  • Annual Report
  • News

Our Team

  • For Employees
  • For Medical Professionals
  • For Vendors
  • For Volunteers

Careers

  • Jobs at Sutter
  • Physician Jobs
  • Graduate Medical Education

Copyright © 2023 Sutter Health. All rights reserved. Sutter Health is a registered trademark of Sutter Health ®, Reg. U.S. Patent & Trademark office.

  • ADA Accessibility
  • Privacy
  • Do Not Sell My Personal Information
  • LinkedIn Opens new window
  • YouTube Opens new window
  • Facebook Opens new window
  • Twitter Opens new window
  • Instagram Opens new window
  • Glassdoor Opens new window

Cookie Policy

We use cookies to give you the best possible user experience. By continuing to use the site, you agree to the use of cookies. Privacy Policy Cookie Preferences

Privacy Policy Cookie Preferences