Utilization & Medical Management

Clearlink delivers utilization and medical management services built on standardized clinical review criteria, structured workflows, and transparent decision making.

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Collaboration Optimization Drive Innovation

Key Capabilities

For compliant, timely utilization decisions.

By combining experienced clinical staff with configurable technology and analytics, our approach expedites appropriate care decisions, predictable throughput, and effective oversight across the utilization lifecycle from initial request through post service review.

Design & Operationalization

Design and operationalization of utilization management programs that support regulatory, accreditation, contractual, and credentialing requirements

Prior Authorization Workflows

Prior authorization workflows structured to reduce review delays caused by incomplete or poorly organized clinical submissions

Clinical Review Criteria

Application of nationally recognized clinical criteria such as InterQual or MCG, with support for custom medical policy development

Concurrent Review Management

Proactive involvement in discharge planning, length of stay management, and care transitions to support level of care decisions

Authorization Optimization

Ongoing evaluation of authorization requirements and trends to confirm use where clinically appropriate and remove reviews that do not add value

Provider Communication

Structured communication with providers to clarify expectations, reduce friction, and improve submission quality

Utilization Analytics

Utilization analytics at the diagnosis, procedure, provider, and facility level combined with claims data for deeper insight

Workflow Visibility Tools

Jiva dashboards and automated task routing to support turnaround time monitoring, workload balance, and decision tracking