The purpose of Clinical Sciences Institute (CSI) is to provide the tools to create Centers of Excellence networks. CSI utilizes publicly reported data-driven metrics, proven clinical criteria and experienced network relations management to qualify our specialty networks.

A variety of responsibilities

CSI physicians provide a variety of services to Optum and its clients. As part of CSI, physicians apply their expertise to the areas of:

• Medical policy
  • Standards of health care and evidence basis
  • Guidelines
  • Technology assessment
• Program evaluation standards
• Clinical operations
  • Benefits administration
  • Appeals
• Medical education

Specialized physician review

In addition, a subset of the CSI physicians review select patient cases. They are asked to provide expert opinions on topics such as:

• The patient's clinical status
• The appropriateness of the proposed therapy
• Alternative treatment options
• Community standards
• Reference(s) to support opinion
• Second opinions on program qualifications
• Independent evaluation of appealed decisions