Toney HealthCare Consulting
Toney HealthCare Consulting provides medical management guidance and talent to support clinical operations across all lines of business, serving all states and Puerto Rico with US-based teams.
Services
Toney HealthCare Consulting provides a wide array of services to support clinical operations. These include utilization management, care management, quality advisory services, and regulatory compliance. The company offers rapid deployment of clinical resources for functions such as utilization management, and provides end-to-end support for audits, accreditations, and renewals. They specialize in medical, behavioral, and specialty benefits for all lines of business, and offer staff augmentation services to quickly fill resource gaps with experienced managed care professionals.
Sector
Toney HealthCare Consulting operates in the healthcare sector, specifically focusing on medical management and clinical operations. The company supports all lines of business including Medicaid, Medicare Advantage, TRICARE, Special Needs, and Commercial. They offer solutions tailored for health plans, ranging from advisory services to insource partnerships and staff augmentation. By serving health plans across all states and Puerto Rico, Toney HealthCare Consulting ensures comprehensive medical management for a wide range of clients.
Expertise and Specialization
Toney HealthCare Consulting boasts over 350 subject matter experts, advisors, and operators who provide expertise in medical management. They excel in operational execution, quality, accreditation, and compliance. The team has experience in quality improvement initiatives and measurement for HEDIS, Stars, and state-required and internal measures. They also offer comprehensive utilization management services, including prior authorization, member and provider engagement, physician review, and handling appeals and grievances.
Partnerships and Collaborations
Toney HealthCare Consulting has established several strategic partnerships to enhance their service delivery. Notably, they have partnered with Rebellis Group to provide comprehensive management consulting and clinical operations solutions. Their expanded insource partnership with St. Vincent Catholic Medical Centers US Family Health Plan enables support for over 13,000 TRICARE Prime beneficiaries. Additionally, investments from Centre Partners and Health Enterprise Partners further bolster their ability to deliver high-quality healthcare consulting services.
Operations and Reach
With US-based teams, Toney HealthCare Consulting serves health plans in all states and Puerto Rico, supporting 48 health plans nationwide. Their solutions are designed to be flexible and comprehensive, including advisory services, insource partnerships, and staff augmentation. By offering dedicated clinical operations teams and leveraging their vast pool of expertise, Toney HealthCare Consulting ensures effective and efficient management of day-to-day operations in healthcare settings.