OptumHealth Care Solutions - Complex Medical Conditions offers products for:
Chronic Kidney Disease
Women's Health Services
- Congenital Heart Disease
- Infertility
- Neonatology
- Pregnancy
Hide Tab
Print View

OptumHealth's Clinical Services Institute includes more than 100 practicing clinical experts from around the country. Through the institute, OptumHealth is able to quantify and qualify clinical excellence and those providers that are stewards of Evidence Based Medicine.

A varied list of responsibilities

CSI physicians provide a variety of services to OptumHealth 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
  • Provider 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