CareReview | Independent Clinical Review and IRO Services

Clinical Solutions Optimizing Care™

CareReview offers clinical solutions that extend beyond the utilization management continuum — supporting better outcomes at every stage of the care journey, not just at the point of authorization. This broader approach helps ensure clinical decision-making translates into meaningful, measurable improvements in patient care.

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Our Commitment

CareReview brings long-term clinical support partnerships to market, ensuring a collaborative approach that benefits everyone in the healthcare continuum.

URAC-accredited IRO

HITRUST R2 Certified

Privately held since 2011

Nationwide specialty-matched reviewer network

Consistently >98% on-time turnaround

URAC-accredited IRO

HITRUST R2 Certified

Privately held since 2011

Nationwide specialty-matched reviewer network

Consistently >98% on-time turnaround

Who We Serve

Health Plans

Accurate, evidence-based review at speed — freeing medical directors for strategic priorities.

Government Programs

Clinical review built to the compliance standards government programs require.

Long-Term Disability Carriers

Specialty-matched physicians and functional capacity experts who strengthen claim defensibility and reduce bad-faith exposure on every determination.

PBMs

Specialty-matched clinical experts who protect PBM neutrality and build plan sponsor confidence in every determination.

Self-Funded Employers

Independent clinical review that meets ERISA fiduciary duty and gives you measurable, reportable outcomes.

TPAs

A scalable, compliant clinical partner that frees TPAs to focus on their self-funded clients.

Solutions

Health Review

We deliver expert clinical review services for group health organizations across commercial, self-funded and government health programs. Our physician and allied health team drives smarter utilization, appeals, quality, and integrity decisions. Whether routine cases or urgent high-volume projects, we ensure timely, accurate reviews that lead to better patient outcomes.

Independent Medical Exam

Our independent medical exam (IME) services provide objective, evidence-based evaluations by board-certified, specialty-matched physicians. We assess treatment, and function to deliver clear decisions with speed and integrity.

Life & Disability

Our disability review services deliver fair, evidence-based assessments of claimant functionality. For short-term, long-term, or complex cases, CareReview physician reviewers provide consistent, objective opinions that uphold integrity and efficiency.

Nurse Review

CareReview's Nurse Review solution gives health plans, TPAs, and PBMs flexible, licensed nurse capacity for initial clinical review — screened against InterQual, MCG, NCD/LCD, or client-specific criteria — with escalation to CareReview's physician panel whenever a case doesn't clearly meet criteria.

Payment Integrity

Our payment integrity services apply specialty-matched physician and coder review to post-pay claims accuracy — going beyond claims-system rules and edits to catch inappropriate payments that pattern-matching alone would miss. By bringing the same clinical rigor we use in utilization review to claims accuracy, we help protect plan spend without disrupting provider relationships.

Pharmacy Review

Our pharmacy benefit solutions are supported by our flexible technology, helping to deliver fast, independent determinations, improving efficiency and outcomes. By matching cases with the right expertise, we promote appropriate medication use through smarter, more accountable decisions.

Workers' Compensation

Our workers' compensation services deliver independent, evidence-based evaluations to support accurate claims and appropriate care. With specialty-matched physicians, we assess medical necessity, treatment appropriateness, and guideline compliance—helping payers and employers make timely decisions that drive recovery and protect claim integrity.

Specialty Bill Review

Our specialty bill review and fee negotiation services help payers and ensure fair reimbursement. Using clinical expertise, analytics, and national benchmarks, we review complex, high-dollar bills for accuracy, necessity, and compliance—while proactive negotiations deliver defensible savings, reduce disputes, and protect care quality.

About CareReview

People expect more than a transactional experience, and that's what we do.

Leadership

At CareReview, exceptional results start with extraordinary leadership. Our executive team has the proven expertise, industry insight, and vision to solve complex healthcare challenges. Driven by a passion for innovation and a relentless commitment to excellence, we work side-by-side with our partners to deliver smarter, faster, and more effective solutions. It's this leadership-first approach that sets CareReview apart in delivering unmatched value to the healthcare organizations we serve.

Certified Network

CareReview connects organizations with a national network of certified, licensed clinical specialists who bring diverse experience and strong communication skills. Our actively practicing clinicians follow the latest evidence-based standards of care, guided by regulatory and internal quality benchmarks. Through ongoing engagement, tailored training, and advanced technology, we foster productive partnerships and empower reviewers to deliver consistent, high-quality results.

Careers With Us

Join the CareReview network of medical experts and become part of a nationwide team dedicated to improving healthcare decisions. Whether you're a physician, allied health professional, or specialist, CareReview provides the resources, support, and professional community you need to grow your career while maintaining work-life balance.

Stradix® – CareReview's Proprietary Cloud Platform

Designed for efficiency and flexibility, Stradix® helps clients meet their unique needs in a cybersecure environment.

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