Oncology Utilization and Quality Management

CareCore Oncology is at the forefront of biological drug utilization management with BioManage. Through the BioManage Program health plans can implement an effective Utilization Management Program that achieves significant cost savings.

The BioManage Program is administered in compliance to URAC and NCQA criteria. The program includes a prior authorization process that is supported by our clinical staff. CareCore Oncology clinicians manage these high cost injectables by applying the appropriate standards of treatment using the latest evidence-based medicine.

Our URAC accredited and NCQA certified Call Center allows for full delegation of the BioManage Program. In the event that outliers such as co-morbidity or circumstances warrant additional review, network physicians have access to doctors within the appropriate specialty to provide further dialogue to accommodate patient needs.

The Current Erythropoiesis-Stimulating Agents (ESA) Program identifies data elements necessary to measure compliance with nationally recognized evidence-based clinical practice criteria established by American Society of Clinical Oncology (ASCO), National Comprehensive Cancer Network (NCCN), and the National Kidney Foundation. These protocols are supported by hematologists and oncologists who are available to network physicians.