powering the future of health care together

Partner With Proven Experience: HM Health Solutions

Enterprise Health Solution

Utilization Management


The Enterprise Health Solution is a comprehensive and integrated health-plan-operations solution that combines a technical platform, best-in-class processes, and consultation from knowledgeable experts all to make it possible for health-plan partners to effectively run their own businesses.

Within the Enterprise Health Solution is the Care Management Product. This product is supported by a variety of processes, including Utilization Management. With this process and its supporting tool, health-plan partners manage their members' utilization and review requests for drugs and services efficiently with a high level of automation. With the Utilization Management tool, we've gained a lot of efficiencies in our day-to-day work.

The dashboard within the Utilization Management tool gives the health plan's managers an easy way to monitor and reassign workflow into assigned tasks by skill. This helps a health-plan partner's personnel increase their capacity and efficiency without being overwhelmed or overused. I love being able to pull reports and manage my workload in real time.

Using a process-driven approach, the Utilization Management tool guides the health plan's users through each case, step by step, and contributes to a smooth workflow. We feel confident we're not missing critical information.

The Utilization Management tool also helps health-plan partners work toward a high level of compliance by assigning work to appropriately skilled resources, delivering critical tasks first, and signaling hours remaining to help maintain strong service levels. Knowing the exact time a case is due is really helpful.

With built-in authorization logic, the Utilization Management tool's algorithm recognizes when there's sufficient information and automatically authorizes an approval. It even sends out required letters to the health plan's members and doctors. This avoids excess time on manual reviews. We're definitely working through our inventory faster, and with such an easy-to-use tool, onboarding time has been significantly reduced.

The Enterprise Health Solution gives health-plan partners tools to improve their own outcomes and efficiency. Powering the future of healthcare together.

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