List of the Top Utilization Management Software in 2025 - Page 2

Envolve is dedicated to revolutionizing the healthcare landscape by utilizing strategic collaborations and a wealth of experience to provide cost-effective, value-based care solutions. The offerings from Envolve MSO empower organizations with vital strategies, proficient personnel, and efficient processes that focus on delivering affordable healthcare and driving authentic change in the industry. As a leading provider of healthcare management services, we incorporate innovation and professional knowledge to improve performance within frameworks that prioritize outcomes and value-based reimbursement. Our all-encompassing healthcare management services enhance both the quality and efficiency of care delivery, underpinned by superior business administration, effective data utilization, clinical excellence, and strong operational support. By focusing on groundbreaking benefit designs across various products nationwide, Envolve plays a significant role in supporting publicly funded, marketplace, and commercial programs, which in turn improves individuals' health and overall quality of life. This unwavering dedication to innovation and enhancement not only strengthens our position in the industry but also plays a critical role in shaping a healthier future for everyone. Ultimately, our vision is to ensure that every individual has access to the high-quality healthcare they deserve.

naviHealth is transforming the landscape of senior care by partnering with health plans and providers to streamline the care transition process using advanced technology. Our primary goal is to simplify these transitions while enhancing the overall experience for seniors, providing essential news, insights, and expert evaluations. Through our unique tools designed for post-acute care planning, naviHealth offers clinical support that not only aids in patient recovery but also reduces preventable healthcare costs. By leveraging our specialized patient care management system, we empower partners to oversee care transitions more efficiently. The integration of in-market clinical assistance with state-of-the-art technology ensures a more seamless recovery path for patients, boosts satisfaction rates, and cuts down on unnecessary expenses related to post-acute care. Additionally, the committed care coordinators at naviHealth play an essential role in fostering clear communication among patients, their families, and healthcare professionals, ensuring that everyone stays informed throughout the recovery journey. This cohesive support network ultimately fosters improved health outcomes and a more streamlined care experience, reinforcing the importance of collaboration in healthcare. In this way, naviHealth exemplifies how innovative strategies can create a positive impact on senior-centered care.

We offer a comprehensive range of innovative products and solutions crafted by industry experts who take online systems, data, and tools to new heights. Our cost-effective system is specifically designed to streamline patient flow, which in turn enhances productivity, overall performance, and the experience of patients. By utilizing our services, you can devote more attention to your patients rather than getting bogged down by administrative tasks. Our solution significantly mitigates issues related to absenteeism, presenteeism, and disabilities within your organization, resulting in a more efficient workforce. With our platform, you can make a profound difference by improving the oversight and promotion of your services. We are dedicated to supporting you in providing care for the elderly demographic, ensuring they receive the attention they deserve. The tools we offer are indispensable in boosting both the effectiveness and efficiency of your operations. Our team performs comprehensive analyses to create customized solutions tailored to your unique requirements. As specialists in healthcare technology, we understand and speak the language of the industry fluently. Our platform drastically reduces the burden of administrative tasks, enabling you to invest more time in direct patient care. We are firm believers that any technological progress that aids human welfare should be shared for the benefit of all. By collaborating, we can pave the way for a healthier future for all individuals in our communities, fostering a spirit of collective well-being and care.

Focusing on the front end is vital for improving the patient financial journey and streamlining revenue cycle results. By adopting unified front-end strategies, healthcare organizations can tackle delivery challenges, which in turn decreases the number of returned mail and outstanding invoices. It's important to limit input mistakes by thoroughly verifying patient identities and demographic information. In addition, checking insurance eligibility at the service point is crucial for maximizing revenue while adhering to legal requirements. Streamlining processes through the automation of prior authorization from beginning to end within seconds can enhance overall efficiency. Moreover, automating notifications ensures that payers receive prompt updates about inpatient hospital admissions. Providing clear communication regarding patients' out-of-pocket costs further enhances financial transparency. By evaluating patients' willingness to pay and their eligibility for financial assistance, hospitals can significantly improve their collection rates. Once considered a secondary priority, patient access has now emerged as a key factor in healthcare settings. Our flexible platform leverages integrated data from multiple verification sources, accompanied by smart guidance, to develop a holistic solution. This integration not only enhances patient access but also propels the overall effectiveness of the organization, ultimately leading to better financial outcomes and patient satisfaction.

Our all-encompassing platform delivers fully cohesive health plan solutions that simplify healthcare for employers, members, providers, and payers, while simultaneously adding substantial value. Valenz merges member-centric services with data-driven insights, fostering connections through personalized assistance that results in superior care and improved health outcomes. We emphasize proactive and regular engagement through impactful education and support services aimed at thwarting more serious and expensive health issues in the future. By opting for Valenz, you can cultivate a healthier member base while continually realizing cost savings for both plans and individual members year after year. To tap into the transparency and resources needed for making informed, quality-focused, and cost-effective choices, let’s explore your route to a more streamlined healthcare experience today. Moreover, the Valenz healthcare ecosystem optimization platform includes a comprehensive array of fully customizable solutions, all integrated within a unified strategic framework, providing a detailed visualization of cost, quality, and utilization opportunities, ensuring you are well-prepared to adeptly navigate the complexities of the healthcare environment. This holistic approach not only enhances efficiency but also empowers stakeholders to make more informed decisions, ultimately leading to better health outcomes for all involved.

Collective compiles patient data into an efficient alert system that empowers emergency department staff to quickly make informed choices, ultimately improving patient outcomes. Alerts are sent out immediately as patients register, targeting those who show excessive use of services or complex needs, and these notifications are also shared with the entire care team to facilitate prompt interventions and steer patients toward more appropriate care alternatives, reducing unnecessary emergency service utilization. The system's notifications are designed to integrate smoothly across various platforms, irrespective of the electronic health record system in place, or can be transmitted through other means such as fax, network printers, emails, or text messages. This flexibility in adapting to the specific needs and workflows of different facilities enhances provider collaboration, providing a cohesive strategy that ensures continuous support for patients throughout their healthcare experience. By optimizing communication channels, this method not only elevates patient care but also leads to a more judicious allocation of healthcare resources, ultimately benefiting the entire healthcare system. The focus on streamlined communication and timely interventions fosters a proactive approach to patient management that can significantly reduce the strain on emergency services.

An all-encompassing hospital management system functions as a holistic solution for managing various operational activities within a healthcare establishment, focusing on fostering a paperless atmosphere while optimizing management workflows. By embracing modern technological advancements, we provide users with the ability to access the system from virtually any device, which significantly boosts overall productivity. The design of the system aims to alleviate the burden on users, allowing them to execute their responsibilities more efficiently and obtain quicker, more precise outcomes. To access the hospital software application, users only require a web browser and an internet connection, making it available across numerous devices and locations globally. This model presents a far more user-friendly alternative to conventional software installations, thereby enhancing the operational efficiency of healthcare organizations. Moreover, our dedication to continuous innovation ensures that we are well-equipped to address the dynamic demands of the healthcare landscape as it evolves. In this way, we strive to not only meet but also anticipate the future needs of our clients.

The process of claims can extend over several months, which complicates the management of related expenses as time progresses. A slight delay of just a few minutes in identifying patient activities can trigger an unnecessary and costly admission to the hospital, a factor that is vital for effective care coordination and the success of value-based contracts. MemberMatch offers these essential insights in real time, providing care teams with the timely information they need to proactively and efficiently manage ongoing care episodes. This strategy aids organizations that bear risk in improving the quality of care while also considering the financial impact of each member interaction throughout the continuum of care, leading to better patient outcomes and enhanced financial health for the entities responsible for their care. By fostering communication between your care team and the involved clinical staff, valuable context is delivered to enhance both the quality and cost-effectiveness of care encounters, which in turn helps to avoid unnecessary admissions to out-of-network facilities and duplicate testing. Ultimately, this timely data equips healthcare providers with the knowledge necessary for making decisions that can greatly benefit both the patients and the organizations they serve, ultimately fostering a more efficient and patient-centered healthcare system.

A comprehensive and versatile toolkit that enables healthcare providers to assess, review, document, and track patient conditions is crucial for delivering quality patient care. The HCS Assessments Design Kit allows users to tailor clinician-level documentation to align with existing or upcoming workflows. For healthcare settings that continue to utilize paper records or different electronic health systems, this kit offers the flexibility to replicate current documentation while ensuring accurate and confidential data collection. Users have access to an extensive library of pre-built assessments, the option to create their own, or the ability to combine both approaches. These assessments can be used either as a one-time documentation instance or for ongoing documentation, with facilities having the discretion to decide if data entry is required or optional. Multiple data entry methods—such as text fields, drop-down menus, radio buttons, and multi-select options—make customization easy and improve workflow productivity. Furthermore, a concise summary of the available templates is included below, providing users with a clear understanding of their options. This holistic approach not only streamlines documentation but also enhances the overall management of patient care processes.

FIT eLearning presents a contemporary and expedited approach for individuals seeking to master the application of feedback-informed treatment, grounded in the cutting-edge PCOMS evidence-based framework. This program is designed to boost your confidence and skills, accommodating a range of learning styles while ensuring a thorough understanding of both PCOMS and FIT methods. It promotes a meaningful evaluation process for clients, allowing for efficient tracking of session ratings through a simple red, yellow, and green signaling system. Moreover, participants have the ability to evaluate their clinical effectiveness across various client demographics, set a professional baseline, and observe steady improvements in their competencies over time. Upon successful completion, learners are awarded a certificate that acknowledges 12 hours of online psychotherapy training centered on feedback-informed treatment. Whether you work independently or are part of a larger healthcare team, FIT eLearning cultivates a robust feedback culture and adeptly incorporates outcome and session rating scales (ORS & SRS) into your therapeutic approach, which ultimately improves client care and engagement. By adopting this forward-thinking training, you will gain the essential tools to foster a more adaptive and impactful therapeutic setting, thereby enhancing the overall experience for both practitioners and clients alike.

The budgeting procedures in hospitals are inherently inefficient and flawed. Typically, these institutions dedicate between three to six months and more than 100,000 hours to develop a budget that frequently miscalculates by millions of dollars and becomes irrelevant almost immediately after finalization. A more effective alternative is necessary, and such an option is indeed available. StrataJazz emerges as the most thorough Advanced Planning tool on the market, revolutionizing how healthcare providers engage in planning, budgeting, forecasting, and managing both operating and capital expenditures. Consequently, the entire planning process is not only streamlined but also becomes significantly more accurate and adaptable to changes. By adopting top-down rolling planning techniques, smoothly integrating pertinent cost data, and leveraging advanced automation alongside best practices in workflow and analysis, StrataJazz cultivates a collaborative and results-oriented budgeting procedure that is remarkably precise and much less time-intensive. This groundbreaking method ultimately enables healthcare organizations to allocate their resources more effectively, thereby improving their overall financial performance and ensuring they can respond promptly to the dynamic nature of the healthcare landscape. Such advancements in budgeting practices are vital for the sustainability and improvement of healthcare services.

Enhancing strategic decision-making and encouraging better collaboration across various sectors of the healthcare ecosystem is essential. The Incedo™ Healthcare Management Platform offers a comprehensive solution for medical management by integrating care management, utilization management, care coordination, and healthcare navigation, all aimed at improving operational efficiency and patient outcomes. This platform fosters enhanced communication and teamwork among Care Management, Clinical, and Utilization Management teams by delivering a consolidated view of the member care plan, which ensures a seamless transition between different management areas. Its sophisticated data capabilities simplify data collection and maintain compliance with CMS regulations through a flexible data repository designed for meticulous data tracking and reporting. Moreover, it facilitates interoperability within systems, thereby promoting better integration across healthcare services. By adopting this cutting-edge platform, healthcare organizations can not only refine their operational workflows but also elevate the quality of care provided to patients. Ultimately, this innovation represents a significant advancement in the pursuit of effective healthcare management.

Explore a specialized analytics-driven tool crafted for healthcare providers to effectively manage claims and remittances, aiming to refine workflows, optimize resource utilization, decrease denial rates, and improve cash flow. Enhance your initial claim acceptance rates with our comprehensive editing suite that ensures compliance with the latest payer guidelines and regulations. Increase your team's productivity by leveraging intuitive workflows that focus on exceptions while automating repetitive tasks. Your staff can easily access our adaptable, cloud-based platform from any device, promoting uninterrupted operations. Simplify the handling of secondary claims with the automatic generation of secondary claims and explanations of benefits (EOB) derived from primary remittance advice. Utilize predictive artificial intelligence to prioritize claims that need urgent attention, facilitating quicker error resolution and reducing the likelihood of denials before submission. Whether you are processing primary paper claims or organizing claims and EOBs for secondary submissions, you will experience enhanced efficiency in your claims processing. By adopting these innovative features, you can substantially improve your claims management approach and take your practice to the next level. This progressive solution not only streamlines operations but also empowers your team to focus on delivering exceptional patient care.

Founded in 1992, Orion has focused on providing cutting-edge technological solutions and expert services to improve workflows in the realms of mental health and addiction. Their flagship offering, AccuCare EHR, is a cloud-based platform meticulously crafted by a team of experienced clinicians and engineers, aimed at streamlining essential agency operations, including clinical, financial, billing, administrative, and research tasks. This software boasts a rich array of features, such as customized screening and assessments, efficient admission and discharge workflows, treatment planning, progress notes, telehealth options, e-prescribing, scheduling, electronic billing, and flexible reporting capabilities. In addition, the AccuCare Web-Based Practice Management System benefits from a dedicated group of specialists who are always available to assist with inquiries related to the system's functionality and its integration into existing documentation and billing practices. Subscribing to AccuCare not only guarantees access to reliable customer support but also ensures that users receive automatic updates and enhancements based on valuable input from actual users, keeping the system aligned with their evolving needs. This ongoing commitment to refining their offerings underscores Orion's mission to empower those working in the addiction and mental health fields, ultimately promoting better care and operational efficiency. Orion's holistic approach aims to foster a supportive environment for professionals to thrive in their critical roles.

Effective inventory management is crucial across numerous industries, but it holds particular importance in the medical device field, where single items can cost thousands and surgical loaner kits may total tens of thousands. By proficiently tracking and managing inventory in the field, both medical device manufacturers and healthcare facilities can increase their sales revenue, decrease the amount of capital tied up in inventory, and lower operational costs. Founded by a talented team of industry professionals with expertise in medical device sales, distribution, logistics, loaner kit processing, and software innovation, Medical Tracking Solutions, Inc. (MTS) aims to address these challenges. Their proprietary software, iTraycer, is available for use by both manufacturers and hospitals, allowing for independent operation or the option of a full-service partnership where MTS works alongside logistics providers for comprehensive case scheduling and management of medical device inventory in the field. This flexible dual-service model effectively meets the varied demands of the medical device sector, ensuring that clients receive tailored solutions that enhance their operational efficiency. By leveraging the capabilities of MTS, stakeholders can adapt to the fast-paced changes within the industry while maintaining a competitive edge.

Effectively managing patient care requires a strategic combination of clinical knowledge and technological solutions. In a sector predominantly driven by human resources, these tools must not only facilitate and improve care management but also contribute significantly to enhancing the financial performance of healthcare organizations. AveCare provides a comprehensive care management framework that includes Care Management (CM), Disease Management (DM), and Utilization Management (UM), while also offering efficient workload handling and competitive pricing options. This forward-thinking approach empowers healthcare entities to optimize their clinical and financial capabilities, resulting in superior care quality and enhanced patient results. By enabling the integration of data from multiple sources, including eligibility, claims, pharmacy information, diagnostic tests, and predictive analytics, AveCare guarantees that healthcare providers have full access to vital patient data. Its design promotes seamless integration, allowing for the streamlined coordination of CM, DM, and UM tasks, thereby ensuring that organizations can conveniently access all pertinent activities from one central location. This comprehensive strategy not only boosts operational efficiency but also fosters a unified approach to delivering patient care, ultimately benefiting both the providers and those they serve. Moreover, as the healthcare landscape evolves, such innovative solutions will become increasingly crucial in addressing the complexities of patient management.

VitalHub provides an extensive array of solutions designed to improve Patient Flow, enhance Operational Visibility, and optimize the Patient Journey, specifically for complex hospital and integrated health systems. Our cutting-edge technologies empower frontline staff, healthcare providers, and management to enrich patient experiences while boosting operational efficiency, which ultimately results in safer healthcare outcomes. We focus on advanced solutions that refine various aspects of care, including patient flow, perioperative services, demand and capacity management, virtual consultations, clinic oversight, and the overall patient journey. Moreover, VitalHub promotes enhanced transparency and communication via real-time visibility throughout the entire system, enabling integrated information exchange for coordinated care and optimizing patient movement within the facility. Our suite of EHR solutions goes beyond standard clinical data collection by providing a comprehensive and nuanced view of patients and clients directly at the point of care, allowing healthcare providers to make informed decisions promptly and efficiently. This dedication to thorough care and operational excellence not only enhances patient satisfaction but also positions VitalHub as a frontrunner in the evolution of healthcare delivery. Additionally, our ongoing commitment to innovation ensures that we continually adapt to the changing needs of the healthcare landscape.

Personify Health emerges as an innovative platform dedicated to personalized health, providing a range of integrated solutions that address health, wellness, and navigation services. Formed from the union of Virgin Pulse and HealthComp in November 2023, this company aims to improve healthcare experiences by delivering services that are tailored, interconnected, and centered around the user. The platform encompasses a variety of offerings, such as health plan management, extensive wellbeing programs, and care navigation support, all designed to empower individuals to engage more proactively in their health journeys. Utilizing data-driven personalization and evidence-based methods, Personify Health assists organizations in optimizing their healthcare investments while simultaneously improving health outcomes for their members. By prioritizing the unique needs and preferences of individuals, Personify Health is not only setting a new benchmark in healthcare but also inspiring a shift towards more individualized care. This commitment to personalization demonstrates the company’s dedication to revolutionizing how health services are perceived and utilized.

The Care Management Suite serves as an all-encompassing, data-driven solution for overseeing care, equipped with a variety of tools and methodologies that aim to improve transparency across both high-risk and at-risk patient demographics. Its design promotes more effective and patient-centered workflows, ultimately striving to boost the quality of care while reducing overall healthcare expenditures. Utilizing data analytics, the suite pinpoints opportunities for enhancement within the care continuum, resulting in improved clinical, operational, and financial outcomes. Comprising three essential applications—Population Builder™: Stratification Module, Population Care Workflow, and Population Care Insights—each component plays a crucial role in the management of care. The suite delivers a unified, comprehensive workflow that integrates processes from patient enrollment and continuous care management to maintaining patient records and fostering collaboration among healthcare teams, ultimately saving valuable time and elevating care standards. Moreover, its analytics-centric Data Operating System aggregates diverse claims and electronic medical record data to provide a complete view of each patient’s health status. By harnessing these insights, healthcare professionals can make better-informed decisions that are geared towards enhancing patient outcomes, which is essential in today’s evolving healthcare landscape. In essence, this innovative suite not only streamlines care management but also empowers providers to deliver superior healthcare services effectively.

Our setup process is designed to be both simple and highly efficient. We proactively integrate our HIPAA-compliant software and services into your existing workflows without disruptions. This innovative software is tailored to assess your patient demographics, identifying those who may qualify for Chronic Care Management (CCM) and other preventive health initiatives. By combining our committed care team with cutting-edge technology, we streamline various administrative tasks such as enrollment, eligibility checks, patient outreach, and detailed record-keeping. Our holistic approach ensures that we remain responsive to your patients' needs, facilitating prompt action when required. Furthermore, our intuitive one-click interface equips healthcare providers with vital insights about patients needing immediate care, enhancing the overall efficiency of the system. Ultimately, our operation is structured to support better patient outcomes while easing the administrative burden on medical practices.

Many patients urgently require your home health services, yet a significant number of doctors who could make referrals are not doing so. This issue can likely be traced back to your sales and marketing teams' failure to utilize the 75% of Medicare claims associated with office visits. Demonstrating your ability to cut costs while improving patient outcomes is crucial. For example, Home Health Agency A can quickly prove its effectiveness compared to Home Health Agency B in terms of hospitalization and readmission rates. With Marketscape for Home Health, you can revamp your sales and marketing strategies to effectively engage the most promising physician and facility referral sources. Our cutting-edge technology and committed support allow you to evaluate how you stack up against your competitors based on various metrics, such as hospitalization and readmission rates, diagnostic categories, acuity levels, time to care initiation, overall care expenditures, and many other quality measures. Utilizing this data enables you to strategically direct your efforts towards increasing referrals, which in turn enhances patient care and elevates the overall reputation of your services. By embracing this approach, you not only meet the immediate needs of patients but also position your agency for long-term success in a competitive market.

Our cutting-edge technology, driven by artificial intelligence (AI), reshapes both structured and unstructured healthcare data into a reliable, high-quality, and standardized dataset suitable for application across your organization. By providing near real-time access to information from diverse systems, our solutions reduce the burden of manual data abstraction, allowing your administrative and clinical teams to regain precious time that can be redirected toward quality enhancements and research initiatives. Our comprehensive array of products and services equips you to collect, analyze, and leverage your data efficiently, regardless of its origin, therapeutic focus, departmental context, or existing reporting, business intelligence, or analytical frameworks. Atlas harnesses the combined strengths of human expertise and AI to simplify the complex task of discovering and interpreting patient data for clinical registries. In parallel, Cartographer adeptly navigates, assesses, and interprets patient information across various platforms, standardizing it into a cohesive format while delivering valuable insights. Ultimately, our groundbreaking solutions not only boost operational efficiency but also facilitate informed decision-making at every level of your organization, fostering a culture of continuous improvement and innovation. By integrating these advanced tools, you position your organization at the forefront of healthcare data management and strategic development.

CareStat serves as SHP's comprehensive analytics platform tailored for post-acute care, seamlessly linking acute care providers, ACOs, payers, and physician groups with skilled nursing facilities and home health agencies. Our objective is to collectively improve the management of patient outcomes, operational efficiency, resource utilization, and partnerships among post-acute care providers. By employing SHP's proprietary readmission algorithms, CareStat synthesizes real-time OASIS and MDS data, ensuring effective patient management across the full continuum of care. This approach is aimed not only at reducing readmission rates and decreasing hospital stays but also at enhancing collaboration and refining referral practices, which ultimately translates to improved patient satisfaction. Additionally, by optimizing the data transfer process for quality and outcome metrics, we enable organizations to conserve precious time. In today's metrics-driven environment, your organization recognizes the importance of actionable insights, and meeting your objectives requires the appropriate tools and expertise for optimal performance. Ultimately, CareStat is engineered to equip providers with the essential insights necessary to achieve superior patient care outcomes, fostering an environment where both patients and providers can thrive together.

CaseTrakker provides a comprehensive care management solution designed to ensure that your team can access the most up-to-date information and crucial tools necessary for effective member management. Their extensive software suite encompasses a variety of features that cater to all dimensions of health management, including care management and utilization reviews. By utilizing these innovative products, organizations can streamline their primary business operations and boost productivity while delivering superior care management outcomes. Furthermore, CaseTrakker's portals offer a tailored, secure, web-based interface for all data, enhancing the user experience. This personalization promotes collaboration among members, healthcare providers, clients, and care management teams, all from any device, facilitating uninterrupted communication and coordination. Overall, the integration of such advanced technology not only enhances operational efficiency but also fortifies the entire care management structure, ultimately leading to better health outcomes for all stakeholders involved.

Acuity Advanced Care™ is a dynamic on-premise platform designed for population health management, accommodating the diverse needs of case, utilization, disease, and overall health management initiatives. By providing organizations with complete control over their environments, this system allows for tailored customization to align with each organization's unique care model. Impressively, more than 90% of those who utilize Acuity Advanced have secured either NCQA or URAC accreditation, or both. The platform merges the benefits of on-premise adaptability with extensive database access, enabling firms to maintain authority over their data storage solutions. Particularly suited for clients with proficient IT teams, Acuity Advanced Care facilitates the effective configuration, security, and oversight of complex systems. Chordline Health emerges as a leading software provider dedicated to serving health plans, TPAs, ACOs, and other entities that assume financial risk. The Chordline team, which comprises skilled clinicians and developers based in the U.S., is renowned for its outstanding managed care knowledge and dedication to exceptional customer service, greatly enhancing the user experience. This unwavering commitment to excellence guarantees that clients receive the necessary support to succeed in a rapidly changing healthcare environment, empowering them to meet their evolving challenges head-on.