Dr. Koo smiling and standing outside.

Utilization management

Sharp Community Medical Group’s Utilization Management Department is responsible for determining what health care services are covered and payable under the health plan.

Clinical guidelines

Sharp Community Medical Group utilizes the care guidelines to determine medical necessity for the plans that we manage. The guidelines are the protected intellectual property of MCG. Sharp Community Medical Group is not able to distribute them without the permission of MCG. MCG has provided a tool that allows Sharp Community Medical Group members and prospective members to view relevant MCG guidelines, however, you will not be able to print them.

Follow the instructions below to access the MCG guidelines:

  1. Access the guidelines, read the disclaimer and accept the terms and conditions

  2. Complete the User information form

  3. Complete the verification process to continue

  4. Click on the arrow icon

  5. Click on the guidelines you wish to view