Member Support

Utilization Management

Utilization Management Decisions for Appropriate Care and Services
Text Size

Horizon NJ Health follows ethical business practices and values as part of how we conduct our Medical Management Program:

  • Utilization Management (UM) decisions are made based on the member’s health care needs and services and the Medicaid/NJ FamilyCare benefit.
  • Horizon NJ Health does not offer rewards or pay to those who make UM decisions.
  • Horizon NJ Health does not offer any rewards or pay to its staff who handle the UM decisions for denials of coverage or services that are needed for good health.
  • Horizon NJ Health does not give rewards or pay to hospitals, doctors and other healthcare professionals to deny or not offer covered health care services that are medically needed.