Toney HealthCare Consulting

Toney HealthCare Consulting offers medical management guidance, leadership, and talent to support clinical operations for various lines of business, including Medicaid, Medicare Advantage, TRICARE, Special Needs, and Commercial. The company has over 350 subject matter experts, advisors, and operators, serving all states and Puerto Rico with US-based teams. Toney HealthCare Consulting supports 48 health plans and offers tailored solutions such as advisory services, insource partnerships, and staff augmentation. Their expertise spans operational execution, quality, accreditation, and compliance, providing services like utilization management, care management, quality advisory services, and regulatory compliance. They partner with Rebellis Group to deliver comprehensive management consulting and clinical operations solutions and have expanded their insource partnership with St. Vincent Catholic Medical Centers US Family Health Plan to support over 13,000 TRICARE Prime beneficiaries. The company has received investment from Centre Partners and Health Enterprise Partners and offers rapid deployment of clinical resources for various healthcare functions. Toney HealthCare Consulting provides end-to-end support for audits, accreditations, and renewals, including readiness assessment, process analysis, project management, staff training, on-site support, and corrective actions. They specialize in medical, behavioral, and specialty benefits for all lines of business and offer staff augmentation services to quickly fill resource gaps with experienced managed care professionals. Their advisory services aim to drive initiatives, improve processes, and expand or install new functions, while their insource partnerships involve dedicated clinical operations teams to handle day-to-day operations and improve processes. The company also has expertise in quality improvement initiatives and measurement for HEDIS, Stars, and state-required and internal measures. Their comprehensive utilization management services include prior authorization, member and provider engagement, physician review, appeals, and grievances. Toney HealthCare Consulting offers a range of clinical and non-clinical support roles, including senior clinical leadership, medical management resources, nurses, physicians, and behavioral health clinicians.