Comprehensive Review Services for Today’s Complex Healthcare
Christopher Place Healthcare Review (CPHCR) provides independent medical review and utilization management services nationwide, supporting health plans, TPAs, and benefit administrators with unbiased, evidence-based clinical determinations.
Our team of U.S.-licensed registered nurses, board-certified physicians, and clinical reviewers integrates seamlessly with existing workflows to support prior authorizations, continuation-of-care determinations, medical-necessity reviews, appeals, and complex case evaluations.
We guarentee quality, compliance, and turnaround times—regardless of jurisdiction.
Care Authorization Nurse Reviews
CPHCR partners with healthcare organizations to deliver expert nurse review services that streamline utilization review and clinical decision-making. Our U.S.-licensed registered nurses (RNs) provide flexible, on-demand clinical review support—helping you manage workload fluctuations, improve turnaround times, and control costs without sacrificing quality or compliance.
With experienced nurse reviewers available when you need them, your team can stay focused on strategic priorities, regulatory requirements, and deliver better outcomes.
Medical Director Authorization
Payers, health plans, Managed Care and Coordinated Care Organizations (MCOs/CCOs), Third-Party Administrators (TPAs), and benefit administrators face increasing pressure to streamline utilization management while maintaining accuracy and regulatory compliance. Prior authorizations, continuation-of-care determinations, and medical-necessity reviews are more complex—and more time-sensitive—than ever.
CPHCR delivers Medical Director Authorization Review services that integrate seamlessly with your existing workflows. Our approach aligns precisely with your clinical and administrative standards, including internal medical policy, plan language, nationally recognized care guidelines, and current standards of care.
Specialty-Matched Physician Reviews
Payers, health plans, Managed Care and Coordinated Care Organizations (MCOs/CCOs), Third-Party Administrators (TPAs), and benefit administrators rely on Specialty-Matched Physician Complex Case Reviews for advanced clinical oversight of high-risk and medically complex cases. Each review is performed by a U.S.-licensed, board-certified physician practicing in the same specialty as the treating provider, ensuring clinically aligned, peer-level evaluation.
This specialty matching supports accurate medical-necessity and level-of-care determinations for complex prior authorizations, continuation-of-care requests, and appeals involving rare conditions, multiple comorbidities, or high-cost therapies.
Our physician reviewers apply current standards of care, evidence-based clinical guidelines, plan-specific medical policy, benefit language, and regulatory requirements to deliver timely, defensible, and clinically appropriate decisions you can rely on.
Pharmacy Benefit Physician Reviews
Pharmacy Benefit Reviews provide payers, health plans, Managed Care and Coordinated Care Organizations (MCOs/CCOs), Third-Party Administrators (TPAs), and benefit administrators with expert clinical oversight of prescription drug utilization. These reviews evaluate medical necessity, formulary compliance, and benefit coveragefor high-cost, specialty, and non-formulary medications, supporting effective pharmacy benefit management.
Our pharmacy benefit reviews are conducted using plan-specific benefit design, formulary requirements, evidence-based clinical guidelines, FDA labeling, and current standards of care to deliver consistent, defensible, and timely determinations that balance member access, clinical appropriateness, and cost control.