Frequently Asked Questions

Table of Contents

1. How does Clearlink support Managed Care Organizations (MCOs)?
2. What measurable results can organizations expect from working with Clearlink?
3. What engagement methods are available for working with Clearlink?
4. What capabilities are included in Clearlink’s clinical management services?
5. What is BPaaS and how does Clearlink’s model transform clinical operations?
6. How does Clearlink use technology to improve healthcare operations?
7. How does Clearlink ensure compliance with CMS, NCQA, and state requirements?
8. How does Clearlink help organizations expand into new markets?
9. Why should organizations partner with Clearlink instead of other consulting firms?
10. Does Clearlink offer educational resources teams can access on their own?

1. How does Clearlink support
   Managed Care Organizations (MCOs)?

   MCOs today face mounting challenges, from controlling costs and complying with regulations to delivering better outcomes for increasingly complex populations. Clearlink provides a comprehensive layer of support designed to address each of these needs. Our work spans clinical management, where we help align care delivery with evidence-based practices, and operational management, where we focus on improving everyday processes to increase efficiency. By leveraging these capabilities, we help MCOs reduce administrative costs, maintain compliance, and drive measurable improvements in both member experience and health outcomes.

2. What measurable results can organizations
   expect from working with Clearlink?

   Organizations that partner with Clearlink see measurable improvements across clinical, operational, and financial performance. By optimizing processes and introducing tailored care models, clients often achieve significant reductions in total cost of care, strengthened compliance frameworks, and higher efficiency in day-to-day operations. Our support has helped health plans successfully prepare for CMS and NCQA audits, build sustainable payment integrity programs that curb waste, and implement utilization management strategies that lower medical spend while preserving quality of care.

   Clearlink’s impact is also evident in member-focused outcomes. Through targeted programs for high-risk and dual-eligible populations, plans have improved engagement, enhanced transitions of care, and realized better health results for complex populations. The combination of reduced costs, improved compliance, and stronger member outcomes translates into a clear return on investment, helping organizations grow while maintaining confidence in the quality and integrity of their programs.

3. What engagement methods are
   available for working with Clearlink?

   No two organizations are the same, which is why we provide a variety of engagement models that align with client objectives, resources, and budgets. Some teams choose to fully outsource processes like utilization management, claims configuration, compliance monitoring, or complex care management, entrusting our specialists to reduce administrative burden and cut costs. Others prefer a co-sourcing model, where Clearlink consultants work together with internal teams to share knowledge and deliver results together. For organizations with specific initiatives, we offer project-based engagements with defined scopes, timelines, and deliverables so that system transformations, program launches, or strategic initiatives stay on track and on budget.

   We also provide staff augmentation, supplying highly skilled consultants who can accelerate performance, as well as interim leadership to fill executive roles during times of transition, offering both strategic guidance and day-to-day management. Our advisory services allow clients to tap into trusted insights that connect business needs with market opportunities, helping maximize program value and support future growth. Regardless of the engagement method, Clearlink adapts to be as hands-on or high-level as needed, always with the goal of achieving efficient collaboration and optimal outcomes.

4. What capabilities are included in
   Clearlink’s clinical management services?

   Clearlink’s clinical management services cover the full spectrum of clinical management, including integrated solutions that combine advanced technology with clinical expertise, population health management, care program design, behavioral health integration, medical cost containment, and grievances and appeals support.

   Clearlink also provides services for regulatory compliance, quality program improvement, application support, risk adjustment optimization, and pharmacy spend management. By combining proven frameworks with rapid deployment teams and interim leadership when needed, we make sure organizations have the resources, oversight, and strategic direction required to deliver high-quality, compliant, and cost-effective care.

5. What is BPaaS and how does Clearlink’s
   model transform clinical operations?

   Business Process as a Service (BPaaS) is a model that delivers critical business functions through a combination of advanced technology and specialized expertise, replacing the need for costly platforms, large in-house teams, and ongoing IT maintenance. Clearlink’s BPaaS solution applies this model to clinical operations by integrating ZeOmega’s KLAS-recognized Jiva platform with our own team of clinicians, coordinators, and analysts. This lets health plans manage utilization management, care management, appeals and grievances, and care coordination with automated workflows, expert oversight, and predictable per member per month pricing instead of heavy upfront investments.

   By embedding compliance support, continuous platform updates, and AI-powered automation into daily processes, our BPaaS model reduces administrative burden, accelerates onboarding, and enables scalability as membership grows. Designed for small-to-midsized organizations and those serving complex populations, Clearlink’s approach delivers greater efficiency, stronger reliability, and measurable improvements in member outcomes so health plans can focus resources on growth and value-based initiatives rather than day-to-day operational hurdles.

6. How does Clearlink use technology to
   improve healthcare operations?

   Clearlink combines advanced platforms with expert services to modernize healthcare operations and deliver greater efficiency, accuracy, and value. Through our Business Process as a Service (BPaaS) model, we integrate ZeOmega’s industry-recognized Jiva clinical platform with hands-on clinical and operational expertise. This approach gives health plans access to powerful tools like real-time dashboards, population health analytics, and automated workflows without the burden of large upfront technology investments.

   We also apply automation and machine learning to core clinical processes, including utilization management, case management, and care coordination. With scalable technology embedded in day-to-day operations, Clearlink provides health plans with predictable costs, stronger performance, and a clear path toward more effective care management in an increasingly complex healthcare environment.

7. How does Clearlink ensure compliance with
   CMS, NCQA, and state requirements?

   Clearlink takes a proactive approach to compliance by aligning regulatory theory with real-world operational practice. Our teams conduct comprehensive readiness assessments to evaluate people, processes, and technologies against CMS, NCQA, and state standards, identifying potential gaps before they become risks. We help organizations prepare for audits with structured plans that include documentation support, monitoring tools, and quality review processes, ensuring every requirement is met with consistency.

   When issues are uncovered, we design and implement corrective action plans that remediate risks and strengthen organizational performance over time. Ongoing regulatory monitoring, paired with the use of analytics and dashboards, allows us to track compliance trends, anticipate evolving requirements, and maintain alignment with accreditation standards. We help health plans build a sustainable compliance framework that reduces liability, safeguards member trust, and supports long-term program success.

8. How does Clearlink help organizations
   expand into new markets?

   We guide organizations through the complexities of market entry by developing new products and benefits that align with state and federal program requirements, while also refining existing offerings to remain competitive. Our team supports provider network development and value-based contracting strategies that broaden member access, improve outcomes, and create sustainable financial performance.

   For organizations serving dual-eligible and special needs populations, Clearlink designs tailored care programs and risk models that support compliance and enhance member engagement. By pairing market intelligence with program design and operational execution, we allow organizations to scale with confidence, capture new opportunities, and establish themselves as strong competitors in changing healthcare landscapes.

9. Why should organizations partner with
   Clearlink instead of other consulting firms?

   Clearlink stands apart from traditional consulting and outsourcing firms because our team is led by former healthcare executives who have firsthand experience running health plans, managing clinical operations, and navigating regulatory pressures. This means we don’t just bring theory to the table; we bring practical insight from leaders who have been in your position and understand what it takes to succeed in today’s complex healthcare environment.

   Unlike firms that only advise from a distance, Clearlink helps organizations design strategies and then execute them, providing the leadership, resources, and accountability needed to achieve meaningful outcomes. This dual strength of insight and execution means our partners gain both immediate impact and long-term value.

10. Does Clearlink offer educational resources
    teams can access on their own?

    Clearlink offers a wide range of resources designed to keep health plans informed and ahead of industry changes. Our resource library includes blogs, case studies, and eBooks that cover emerging healthcare trends and provide actionable guidance on managing risk, launching new products, optimizing spend, and advancing value-based care. These materials are created by Clearlink’s team of experienced healthcare leaders and consultants, offering practical insights drawn from real-world experience. Whether you’re exploring new opportunities or looking for proven strategies to strengthen existing operations, our resources can help guide your next steps. Before reaching out to connect with our team directly, these self-serve materials are an excellent way to learn more about our perspectives and the value we bring.