End-to-End Managed Care Consulting Services

Clearlink empowers managed care organizations to transform clinical operations into high-performing strategic assets, driving measurable impact and long-term success.

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Clinical Management Services

Identify opportunities to adopt transformational and holistic clinical solutions, even for the most complex populations. Generate best-in-class outcomes, decrease spend, and continually accelerate financial performance.

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Operational Management Services

Achieve optimal performance by successfully navigating and managing the complex operational, financial, and technological functions and activities of a constantly shifting healthcare environment. Become more equipped to stay agile with solutions that offer effective program and project management, system optimization, data-driven innovation, and cross-departmental alignment.

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Expert
Insights

Innovative
Processes

Comprehensive
Solutions

We engaged Clearlink to benefit from their national perspective, understanding of industry benchmarks, and experience with other health care organizations – especially Medicare Managed Care Organizations – to improve care management for our members. Our work with Clearlink allowed us to assess and implement opportunities for improvement while we continued to manage business as usual.

Marylou Buyse M.D., former Chief Medical Officer, Neighborhood Health Plan of Rhode Island

“Clearlink brought our vision to life, developing data-driven reports that support the review of services in our prior authorization program and established a dedicated committee to review best practices in prior authorization. With their support, we are prepared for the future, ensuring high-quality, cost-effective care for our members while minimizing provider and member abrasion.”

KRISTIN POTH, AVP, JOHNS HOPKINS HEALTH CARE (JHHC)

The Clearlink Way

How we develop tailored, end-to-end programs that successfully manage healthcare spend, achieve accelerated operational efficiency, and serve more members with higher quality, equitable care.

Experience our 5-Step Process

Discovery

We begin with an in-depth review of your existing processes, including relevant programs, policies, workflows, contracts, KPIs, and business systems. Then we discuss the biggest challenges you currently face and the goals you have for growth.

Analysis

We evaluate your performance against industry standards, accreditation needs, contractual compliance demands, and regulatory requirements applicable to your business model and share a preliminary plan for addressing identified gaps.

Strategy

We build and finalize a custom program and implementation timeline using select services from our suite of clinical and operational solutions. This includes intended project tactics, key performance metrics, and projected results.

Delivery

We execute your strategic program through a dedicated team of specialized consultants who work as an extension of your organization to deliver comprehensive solutions and expertise with full lifecycle support.

Optimization

We continue to optimize your program to meet new needs and achieve efficiencies at the enterprise and operational level. We remain focused on helping your organization maintain sustainable processes and navigate change.

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Blogs

AI-Enabled Risk Stratification: Moving from Risk Scores to Timely Member Action

A member with several months of high utilization is easy to flag. The harder and more valuable task is identifying a member whose risk is changing before the pattern becomes obvious through paid claims. That requires models capable of drawing from a broader mix of information, detecting movement across time, and separating actionable risk from expensive events that a care management program is unlikely to influence. AI can strengthen that process, but health plans still have to decide what risk they want to predict, how scores will affect work queues, which interventions correspond to each signal, and how member responses will feed back into future decisions. Without those connections, a more sophisticated score can become another data point competing for attention.

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Blogs

Healthcare Analytics KPIs Every Payer Executive Should Be Watching

Healthcare analytics is much more than building another dashboard for basic reporting. For payer executives, it’s identifying the operational signals that consistently predict financial performance, member experience, quality outcomes, and regulatory performance before quarterly results arrive. To get the most value from healthcare analytics, health plans have to focus leadership attention on the handful of metrics that reveal where performance is improving, where risk is building, and where action can make the biggest difference.

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End-to-End Managed Care Consulting Services

Clinical Management Services

Operational Management Services

Expert Insights

Innovative Processes

Comprehensive Solutions

The Clearlink Way

Discovery

Analysis

Strategy

Delivery

Optimization

Empowering Effective D-SNP Case Management

Expert
Insights

Innovative
Processes

Comprehensive
Solutions