Improving Care Quality While Controlling Costs
At First Choice, medical management isn’t an afterthought—it’s the backbone of our promise to deliver high-quality, cost-effective healthcare. We take a proactive, hands-on approach to ensure that every provider, service, and process in our network supports better outcomes for patients and smarter spending for administrators.
Whether you’re a TPA, broker, employer, or Medicare Advantage partner, our medical management services help ensure the care your members receive is appropriate, necessary, and delivered by highly qualified professionals.
Credentialing You Can Trust
Every provider in the First Choice network is carefully vetted using NCQA-aligned credentialing standards. We go beyond surface-level qualifications to assess licensing, malpractice history, clinical performance, and overall compliance. Credentialing is not just a box we check—it’s a commitment to safety and accountability.
We also offer fast, efficient provider onboarding for nominated physicians or facilities, ensuring that network expansion doesn’t slow you down.
Utilization Review & Oversight
We actively monitor the utilization of medical services to prevent unnecessary procedures, duplicate testing, or overuse of high-cost services. Our review process includes:
- Pre-authorization checks for certain procedures.
- Retrospective review for high-cost claims.
- Support for complex case evaluations and provider engagement.
This ensures your members receive the right care at the right time—without excess waste or financial risk.
Coordinated Care. Better Results.
We help drive better clinical outcomes through care coordination support and provider collaboration. From chronic disease management to transitions of care, our goal is to close gaps, reduce re-admissions, and support overall health plan performance.
Data-Driven Support
Our team is equipped to provide claims data analysis, quality reporting, and insights that help you fine-tune your health plan performance over time.
Protect your network’s integrity. Optimize your spend. Deliver better care.
Let’s talk about how First Choice’s medical management services can work for you.