Utilization management

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All, some, or just a little

With a flexible approach, you don’t have to settle for a blanket offering. Our Utilization Management (UM) program gives you options that fit your budget, while driving efficiency. Our deep pool of experts remove barriers from complex medical, behavioral, and pharmacy UM operations, allowing our clients to focus on more critical areas, like their patients and members.

Time to Separate

In today’s healthcare landscape, clinical and non-clinical teams spend 30-40% of their time on administrative tasks, including working in multiple systems with multiple views, with exorbitant amounts of data and manual lookup. Enter EXL Health UM Operations. With a variety of best-in-class technologies and a proven system that gets results, we take UM workflows where others don’t.

Proven outcomes

96%
reduction in pre-certification case handling time
15%
Improvement in document efficienc
3
of the 4 top-tier health plans use our UM services
Improved
member and provider experiences and satisfaction
Improved
Operational and administrative cost
Improved
consistency, accuracy and efficiency

Our model

Through end-to-end Utilization Management services and solutions, our team of UM experts take the heavy lifting of complex medical, behavioral and pharmacy UM operations off of our clients’ shoulders and allows them to focus on more critical areas of their performance.

Our teams of nurses, physicians, behavioral experts and non-clinicians can manage some, or all of the authorization lifecycle using a unique combination of technology, analytics, data and domain expertise, customized to meet client requirements.

Our model is highly flexible and can include fully or partially delegated services, capacity services, or standalone technology, analytics and/or automation.

Our solutions

Evolving solutions for evolving needs