What we do

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.

End-to-End Services
EXL Health delivers end-to-end Utilization Management services across medical, behavioral and pharmacy. These services are delivered using proven clinical guidelines and cover the full pre-authorization lifecycle.
Fully Accredited Services
EXL Health maintains robust and comprehensive processes, policies and procedures to deliver compliant and accredited services to our clients, including clinical oversight led by the EXL Senior Medical Director.
  • Deliver URAC accredited Utilization Management services across medical, behavioral and pharmacy
  • Deliver NCQA accredited Utilization and Case Management(CM) services
  • Deliver URAC accredited services for Worker’s Compensation
  • Maintain state Utilization Review licensure across 22 U.S. states with the ability to apply for additional state licensure(s) to meet client needs
  • Comply with all state and federal regulations and requirements
Deep Domain Expertise
EXL Health demonstrates investment in our talent pool of utilization and case management team members to deliver high quality services to our clients. We employ professionals with experience and domain expertise while augmenting tenure with industry leading training and education.
  • Aligned staffing needs to meet the requirements of our clients
  • EXL Health employs 2,400+ clinical resources in our U.S. and global operations workforces
  • Interdisciplinary teams comprised of medical directors, pharmacists, registered nurses, licensed behavioral health clinicians, and non-clinical staff
  • EXL proprietary Healthcare and Customer Experience Academies equip EXL client teams to deliver superior service for our clients
  • Demonstrated excellence in staff recruiting, hiring and in-depth domain training to meet all compliance, accreditation and client requirements
Proven Outcomes
Who we serve

EXL Health partners with and delivers our Utilization Management services to both health plan payer and provider organizations. We support driving value-based outcomes and transformation in order to support improvements to member health outcomes, medical cost containment and quality compliance. 

Supporting payers in indentifying and decreasing administrative waste, reducing overall health claim expenditures, and optimizing revenue opportunities while improving member care quality and effectively managing population risk.

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Serving provider organizations looking to proactively manage risk, improve quality outcomes and optimize network performance.

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Why EXL HEALTH
Digital Transformation. Strengthened by deep healthcare knowledge.

EXL Health's clinical teams, analytics experts, and Care Management technologists, backed by unparalleled knowledge of the changing healthcare landscape, deliver solutions that address the industry’s most critical challenges. We partner with clients to achieve optimized outcomes, both financial and clinical.

These efforts have received recognition from healthcare industry analysts; most recently we earned high ratings in the 2020 KLAS Risk Adjustment & Analytics Vendor Performance report, and received Gartner’s Customer Choice award, a Customer Choice Distinction for Data and Analytics Providers in 2020 – based solely on customer feedback.

5 OF THE TOP 10 US
health plans partner with us
1 IN 6 AMERICAN
lives touched by CareRadius®
2,100+ NURSES
delivering care management outcomes

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