A public, not-for-profit Medicaid HMO plan sought help conducting an end-to-end assessment of its utilization management (UM) department to improve the effectiveness and efficiency of its operations. With an outdated medical management system and no clear method of determining productivity success, meeting compliance requirements, and following quality measures, the health plan needed support in adopting reporting tools, aligning processes, and upgrading technology solutions.
With multifaceted services from Clearlink over the course of six months, the organization was able to develop an all-in-one UM reporting suite, improve critical workflows, document new processes, and deliver staff training for the department.
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