Toney Healthcare brings peace of mind to health plans’ clinical operations by providing resources and expertise in all aspects of medical management, including operational execution, quality, accreditation and compliance.
We meet you where you are in terms of the support you need whether it be filling resource gaps, providing guidance or fully executing day-to-day clinical operations on your behalf.
Our team of over 350 individuals includes nationally recognized subject matter experts, physician advisors, senior nurse executives, frontline clinical operators and other specialists.
We offer solutions for medical, behavioral and specialty benefits for all plan types and lines of business (Medicaid, MLTSS, Medicare, SNP, Commercial), especially those being served by ACAP plans. Our services include:
• Medical & Behavioral Utilization Management
• Medical and Behavioral Physician Review Services
• Appeals & Grievances
• Specialty UM (e.g., ABA, SUD, IEP)
• Medical, Behavioral & Integrated Case Management
• Model of Care (D, C, I-SNP)
• Med-Psych Care Management
• Specialty Care Management (e.g., SUD, ASD)
Compliance & Quality
• Regulatory & Compliance
• Accreditation (NCQA, URAC)
• Quality Initiatives & Measurement (HEDIS, Stars, etc.)
• Risk Adjustment & Payment Integrity
Toney Healthcare services offer the following benefits:
• Extensive managed care/medical management experience and expertise
• Local, regional and national perspectives for best practices
• Complete performance visibility – operating on your system
• Rapid deployment with US-based resources & Compliance
We are a Gold-level Preferred Vendor who has proudly served ACAP plans for over 8 years.
Please visit www.toneyhealthcare.com for more information.
Chief Growth Officer
3903 Northdale Boulevard, Suite 220E
Tampa, FL 33624