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 Professionals (NPP)
  • Saint Mary's Preferred Health Care Network (PHCN)
  • Universal Health Network (UHN)

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Nevada Preferred Healthcare Providers

UM/CM Services ~ Nevada Preferred Healthcare Providers

  

Utilization Management

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 utilization and case management products making every effort to ensure members receive appropriate care in a cost-effective manner.  This option is made available through Reno-based, NCQA accredited, Prominence Health Plans.  Which offer the expertise of registered nurses and medical directors to determine necessity of in-patient and outpatient care and access to quality contracted facilities.

Case Management

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.

Case Management:

  • helps facilitate early identification
  • prevents re-hospitalization
  • significantly reducing costs
  • educates patients and members to make choices that contribute to a healthier lifestyle