OptumHealth Care Solutions - Complex Medical Conditions offers products for:
Transplantation
Cancer
Chronic Kidney Disease
Bariatric
Women's Health Services
- Congenital Heart Disease
- Infertility
- Neonatology
- Pregnancy
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The Clinical Sciences Institute

Optum's Clinical Sciences Institute (CSI) includes more than 100 practicing medical experts from around the country. Through the institute, Optum is able to quantify and qualify clinical excellence and identify the programs that best exemplify the highest quality based on evidence-based Medicine.



A Variety of Responsibilities

CSI physicians provide a variety of services to Optum and its clients. As part of CSI, physicians apply their expertise to the areas of:

  • Medical policy
    • Standards of health care and evidence basis
    • Guidelines
    • Technology assessment
  • Program evaluation standards
  • Clinical operations
    • Benefits administration
    • Appeals
  • Medical education


Specialized Physician Review

In addition, a subset of the CSI physicians are called upon to review select patient cases. They are asked to provide expert opinions on topics such as:

  • The patient's clinical status
  • The appropriateness of the proposed therapy
  • Alternative treatment options
  • Community standards
  • Reference(s) to support opinion
  • Second opinion on program qualifications
  • Independent evaluation of appealed decisions

 

NCQA has reviewed and certified Optum's Credentialing and Utilization Management functions only. Date granted: 7/1/2014. Expiration date: 7/1/2016. For complete details on the scope of this review, visit www.ncqa.org.