Utilization management software provides hospitals and health care practices a process with which to evaluate health care services and procedures provided to patients to determine their medical necessity. Health care administrators depend on utilization management processes to ensure that their physicians are maintaining a high quality of care and administering effective treatments while minimizing costs. Utilization management review and determination can occur before (prospective utilization review), during (concurrent utilization review), or after (retrospective utilization review) patient treatment has been scheduled and provided; software supports action during any of those three stages. Additionally, utilization management software has the potential to better the working relationship between providers and payers. By leveraging patient data found in EHRs, health care providers can apply real-time data to the review process, adhere to regulations, and optimize revenue cycle management. Registered nurses equipped with utilization management certification, case managers, and physicians are the main players during the review process.
To qualify for inclusion in the Utilization Management category, a product must:
ACUITY Advanced Care is an integrated care management software application that robustly supports case, utilization, disease and population health management programs. The ACUITY suite offers a user-friendly experience with full flexibility to support even the most challenging case management workflows
The AveCare Software platform enables collaborative care through integrated solutions for: Case Management, Disease Management, Utilization Management , Patient Advocacy. AveCare Care Management Software enables Health Plans, Third Party Administrators (TPAs), Independent Review Organizations (IROs), Physician Networks and other Healthcare Delivery Organizations to optimize clinical and financial resources while improving patient outcomes.
eQCare Utilization Management (UM) services assist health plans by providing a multi-faceted approach to managing requests for medical services ensuring the services are medically appropriate and necessary through the use of evidence-based clinical guidelines and physician input. Utilization Management workflows and processes allow requests for services to be initiated through multiple channels including web entry, fax and/or telephonic submission supported by a network of professional service representatives backed by a large clinical staff of nurses and physicians.
Graham Healthcare Group's Home Health Utilization Management solution empowers health plans to better manage their home health utilization and network of providers by leveraging quality, utilization, and cost data from the health plan's existing home health providers.
Visually interact with data for easier insight into ambulatory surgery center or revenue cycle operations. Quickly access key performance indicators (KPIs) to analyze financial performance. Easily identify trends and analyze historical data to identify problem areas within an organization.