CareRadius® Suite

Cloud-based total population health solution

Streamline care management

CareRadius® integrates data from multiple sources and shares it between health plans, practitioners and members in realtime, enhancing clinical decision-making, improving workflows, and reducing administrative costs.

The workflow is automated across the care continuum – making it easier to navigate member and provider interactions.

Improving member health

Drive better outcomes to improve quality of care, patient experience and affordability.

This holistic view of the member provides real-time information to create personalized care plans, make timely and accurate decisions, and provide earlier interventions to improve member health outcomes.

Enhancing member experience

Improve member satisfaction through proactive interventions, and driving campaigns.

Payment integrity

CareRadius® functionality supports your organization in adhering to healthcare accreditation and regulatory requirements. Identify and correct insufficiencies by applying analytic techniques to determine likelihood of litigation and opportunities for risk management.

Revenue optimization

Highly flexible and configurable, you can respond rapidly to the ever-changing healthcare landscape without exhausting IT resources. Enhance revenue through increasing Star Rating and maximizing reimbursement for HCC risk adjustment factors.


Web-based application

There are no client-side applications, plug-ins, or other elements to manage across the enterprise.

  • N-tier architecture
  • Service-oriented architecture
  • Extensible
  • Security integration
  • Cloud-based offering (see separate collateral)
  • Extended rules engine

Add business rules such as data validation, automated processing and workflow routing, as well as directly accesses underlying or external database, or call local or remote web-services.

Security integration

Entirely role-based, the security subsystem supports integration with enterprise repositories, such as ActiveDirectory or LDAP, as well as identity and authentication systems supporting single-sign-on.

Who to Contact?

Data visualization dashboards

Rich data visualization tools powered by Sisense were added to allow users to make fast, accurate decisions by interacting with the data they need to gain business insights and derive value.

“With Sisense, you can easily get value from your data without training or experience since it’s just so easy to produce quality, insightful analytics – a tool with no learning curve.” — James Davison, Senior Data Analyst

Reporting and letter generation

CareRadius® provides standard out of the box reports and letters with special focus on CMS requirements for member and provider correspondence, and ODAG Universe reports. Both real-time and batch scenarios for letter generation.

CareRadius® Direct

Field case manager tool for mobile devices. This tool supports offline delivery of surveys to members in their homes or community, with ability to synch results into CareRadius® when the device is connected.


Decrease costs by reducing phone calls and faxes, improve regulatory timeframes, and increase provider satisfaction through the use of the self-service provider portal. The tool’s easy-to-use, modern interface combined with the power of authorization “profiles” to streamline authorization entry, modification, and status lookup is now even easier.

New pre-authorization verification functionality allows providers to quickly determine if an authorization is required at all – and – when an authorization is required all the information used to make the determination is entered automatically into the actual authorization form. Bi-directional communication facilitates the reduction of manual processing for typical scenarios, such as requesting additional clinical information from providers and informing providers of authorization statuses. Other features include the ability for providers to interact with the member’s care plans and be notified of gaps in care.

Product Features


Focus on member outcomes, not content creation with a collection of evidence based surveys/ assessments and care plans that assist in meeting NCQA and URAC accreditation.

Surveys and care plans are available for:

  • Asthma
  • Coronary Artery Disease
  • COPD
  • Depression Assessment
  • Diabetes
  • Heart failure
  • Maternity
  • Pediatric Asthma Assessment
  • Complex Case Management
  • Pharmacy UM

Ability to incorporate pharmacy vendor data sets values to support NDC to J code cross walk and support specialty pharmacy drug utilization management.

Member dual eligibility

Includes the ability to designate a plan at the authorization service level. Managed long term care Supports MTLSS surveys and associated care plans and field case management.


Synchs to Outlook allowing easy scheduling of member intervention follow up dates.

Upcoming features

Risk ID and stratification models

Find, prioritize, and act on target populations. Supported disease states, e.g., diabetes, align with CareAdvise. Content includes clinicianrecommended actions to improve health outcomes and decrease healthcare costs.

Case roster re-assignment

Allows case and disease managers, along with their team leads/supervisors to temporarily or permanently reassign cases within CareRadius®.

Care plan audit support

Updates will be provided to support the new NCQA requirements.

Mobile care plans

Field care managers will be able to collaborate with members on their individual care plans.

Additional dashboards

CM/DM and UM User Dashboards

For more information

Call: 866-828-8263

Contact US