Delegated Clinical Services & BPaaS Solutions for MCOs

Delegated Care Management (CM) Solutions

Strengthen your care management program with integrated processes that support holistic, person-centered care. Clearlink helps you design and optimize CM workflows that elevate engagement, improve outcomes, and ensure members receive the right support at the right time. With evidence-based assessments and individualized, tailored care plans, we help you reduce risk, close gaps, and advance whole-person care.

Key Services

• Develop holistic care plans that integrate physical, behavioral, and social needs to support comprehensive, whole-person care
• Implement engagement strategies and workflows that drive meaningful member participation and follow-through
• Improve member outcomes by standardizing processes, coordinating services, and supporting timely interventions
• Leverage evidence-based assessments to ensure consistent clinical decision-making and appropriate levels of engagement and care
• Create plan-of-care templates that streamline documentation, reinforce best practices, and support compliant, high-quality delivery

Utilization & Medical Management

Enhance your UM function with consistent, compliant processes that ensure the appropriate and efficient use of services across the continuum of care. Clearlink delivers strategies that improve access, reduce unnecessary costs, and strengthen insights into high-risk areas. Our data-driven approach helps identify trends, improve care transitions, and ultimately drive a more effective UM program with measurable ROI.

Key Services

• Design utilization workflows that support trackable, improved ROI through reduced unnecessary services and optimized resource use
• Analyze utilization trends and emerging patterns to identify opportunities for cost savings, improved access, and proactive intervention
• Implement processes that ensure timely access to clinically appropriate care while maintaining compliance with regulatory standards
• Manage utilization, readmissions, and care transitions through structured review processes that reduce risk and promote continuity of care

Grievances & Appeals Management

Leverage Grievances and Appeals (G&A) processes that deliver timely, fair, unbiased, and appropriate resolution necessary for compliance. Clearlink can successfully manage this area of health plan risk. With the ability to address dissatisfaction and requests for prompt reviews of actions is central in protecting member rights, ensuring appropriate care, and promoting provider satisfaction.

Key Services

• Manage grievances and appeals through delivery of standard, best practice procedure and process, structured workflows, and work queue management for timely resolution
• Perform hands-on identification and resolution work to streamline operations and reduce errors
• Clear documentation standards, monitoring tools, and quality review processes that support timely resolution and regulatory reporting
• Conduct root cause analysis and develop performance improvement plans to reduce risk
• Develop culturally, linguistically appropriate G&A communication with oral, written, and language assistance

Provider Portal Assistance

Improve provider experience and streamline collaboration with portal-enabled access to essential clinical and administrative functions. Clearlink helps integrate and optimize provider portal workflows, enabling real-time visibility, faster decisions, and seamless communication between providers and care teams. This enhanced connectivity reduces administrative burden and supports higher-quality, coordinated care.

Key Services

• Enable direct provider access through your existing portal, improving coordination and reducing administrative delays
• Provide transparent visibility into key information, helping providers make timely, informed decisions at the point of care
• Streamline authorization processes by enabling providers to submit requests and receive auto-approvals when criteria are met
• Offer real-time access to member care plans, supporting accurate documentation, improved collaboration, and more coordinated care