Utilization Management Services
ID: RFP-UHAA-2025000149-1
• State: Colorado
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Description
Background
The State of Colorado, through the Department of Health Care Policy and Financing (HCPF), is seeking proposals for Utilization Management Services. The goal of this contract is to enhance the management of healthcare services provided to individuals under the state's care, ensuring efficient use of resources while maintaining high standards of care.
Work Details
The contractor will be responsible for providing comprehensive Utilization Management Services as outlined in Exhibit B, Statement of Work. This includes:
- Conducting reviews of medical necessity for services requested by providers.
- Implementing utilization review processes that comply with state and federal regulations.
- Providing recommendations for care based on clinical guidelines and best practices.
- Collaborating with healthcare providers to ensure appropriate service delivery.
- Reporting on utilization trends and outcomes to the State.
- Maintaining confidentiality and security of all patient information as per HIPAA regulations.
Period of Performance
The contract will commence on the effective date specified in the contract cover page and will continue for an initial term as defined, with options for extensions not exceeding five years total duration.
Place of Performance
Services will primarily be performed within the State of Colorado, with potential for remote operations as necessary.
The State of Colorado, through the Department of Health Care Policy and Financing (HCPF), is seeking proposals for Utilization Management Services. The goal of this contract is to enhance the management of healthcare services provided to individuals under the state's care, ensuring efficient use of resources while maintaining high standards of care.
Work Details
The contractor will be responsible for providing comprehensive Utilization Management Services as outlined in Exhibit B, Statement of Work. This includes:
- Conducting reviews of medical necessity for services requested by providers.
- Implementing utilization review processes that comply with state and federal regulations.
- Providing recommendations for care based on clinical guidelines and best practices.
- Collaborating with healthcare providers to ensure appropriate service delivery.
- Reporting on utilization trends and outcomes to the State.
- Maintaining confidentiality and security of all patient information as per HIPAA regulations.
Period of Performance
The contract will commence on the effective date specified in the contract cover page and will continue for an initial term as defined, with options for extensions not exceeding five years total duration.
Place of Performance
Services will primarily be performed within the State of Colorado, with potential for remote operations as necessary.
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Overview
Opportunity Type
Request for Proposals (RFP)
Opportunity ID
RFP-UHAA-2025000149-1
Response Deadline
April 11, 2025
Past Due
Date Posted
Feb. 28, 2025
Source
Source Notes
Source does not have a linkable page for this opportunity. To find the opportunity, go to the Source website listed above and search for the Opportunity ID.
Est. Value Range
Experimental
$5,000,000 - $15,000,000
(AI estimate)
Agency Distribution
High
On 2/28/25 HCPF - Executive Directors Office in Colorado issued Request for Proposals (RFP) Utilization Management Services with ID RFP-UHAA-2025000149-1 due 4/10/25.
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Documents
Posted documents for Utilization Management Services
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Classifications
Opportunity Classification
Personal Svcs