Utilization Management

The Humana – CareSource Utilization Management (UM) team will review the health care services you get, based on established criteria or guidelines. We review to make sure it is the best care for your needs. If you have questions about how your care is reviewed, you can contact the UM team through Member Services and the representative will connect you. When calling, please keep the following in mind:

  • UM is open for calls Monday – Friday from 8 a.m. to 5 p.m. Eastern Standard Time (EST).
  • You may leave a message about UM issues after normal business hours.
  • You may also use the website to contact UM during and after normal business hours.
  • If you are contacted by UM staff members, they will identify themselves with their names, titles and the organization name (Humana – CareSource) when they call about UM issues.
  • Staff are available to accept collect calls regarding UM issues.
  • Staff are accessible to callers who have questions about the UM process.
  • UM is available to conduct utilization review during normal business hours and extended hours on Monday, Friday, and federal holidays until 6 p.m.

Member Services: 1-855-852-7005 (TTY: 1-800-648-6056 or 711), 7 a.m. – 7 p.m., Monday – Friday