Best Utilization Management Software

Utilization management software provides hospitals and health care practices a process with which to evaluate health care services and procedures provided to patients to determine their medical necessity. Health care administrators depend on utilization management processes to ensure that their physicians are maintaining a high quality of care and administering effective treatments while minimizing costs. Utilization management review and determination can occur before (prospective utilization review), during (concurrent utilization review), or after (retrospective utilization review) patient treatment has been scheduled and provided; software supports action during any of those three stages. Additionally, utilization management software has the potential to better the working relationship between providers and payers. By leveraging patient data found in EHRs, health care providers can apply real-time data to the review process, adhere to regulations, and optimize revenue cycle management. Registered nurses equipped with utilization management certification, case managers, and physicians are the main players during the review process.

To qualify for inclusion in the Utilization Management category, a product must:

  • Set up trigger workflows
  • Automate approvals and authorizations of medical services and procedures
  • Simplify or automate reviews of medical services and procedures
  • Aggregate clinical and financial data across a health care organization
  • Integrate with EHRs or easily leverage EHR data to trigger relevant workflows

Compare Utilization Management Software

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    Pharmacy 4.0 is an approach that improves quality, flexibility, speed, and productivity of the pharmacy production process.

    TreeAge Pro covers all your modeling needs. Both products include the base model building and analysis tools and the Excel Module.

    StrataJazz application is a single integrated software platform that includes modules for capital planning, contract modeling, cost accounting, cost management, decision support, financial forecasting, management reporting, operational budgeting and performance improvement and strategic planning.

    BedTracking is a patient management software with interactive voice response, room cleaning requests automation, bed status tracking, and reporting tools.

    Access Bed Control is a patient management software that provides multi-service department integration for the function of bed control.

    ACUITY Advanced Care is an integrated care management software application that robustly supports case, utilization, disease and population health management programs. The ACUITY suite offers a user-friendly experience with full flexibility to support even the most challenging case management workflows

    Helping achieve population health management goals, Population Health Analytics enables organizations to leverage their data to more effectively manage patient populations, identify gaps in care, and get actionable insights at the point of care.

    A risk management analytics and advisory services package for ACOs, CINs, providers, and hospitals that want to improve resource utilization, reduce drug costs, and coordinate care for chronic patient populations

    An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, and accelerate cash flow.

    The AveCare Software platform enables collaborative care through integrated solutions for: Case Management, Disease Management, Utilization Management , Patient Advocacy. AveCare Care Management Software enables Health Plans, Third Party Administrators (TPAs), Independent Review Organizations (IROs), Physician Networks and other Healthcare Delivery Organizations to optimize clinical and financial resources while improving patient outcomes.

    Helps hospitals use data to improve operations liberating clinicians from data entry work

    CaseTrakker products provide a comprehensive care management solution designed to ensure that your users always have the most up-to-date information and the tools to manage their members efficiently.

    Midas+ Care Management is a quality control software for healthcare providers to manage risk, track cases, create compliance reports, and collect patient data.

    eQCare Utilization Management (UM) services assist health plans by providing a multi-faceted approach to managing requests for medical services ensuring the services are medically appropriate and necessary through the use of evidence-based clinical guidelines and physician input. Utilization Management workflows and processes allow requests for services to be initiated through multiple channels including web entry, fax and/or telephonic submission supported by a network of professional service r

    The Health Catalyst Data Operating System (DOS) is a breakthrough engineering approach that combines the features of data warehousing, clinical data repositories, and health information exchanges in a single, common-sense technology platform.

    Graham Healthcare Group's Home Health Utilization Management solution empowers health plans to better manage their home health utilization and network of providers by leveraging quality, utilization, and cost data from the health plan's existing home health providers.

    LTC wireless nurse call system allows you to send and receive alerts and notifications, locate residents/staff/equipment, control access, and document tasks to provide quality care with increased speed and efficiency.

    An automation solution for providers/care managers that want to leverage their EHR to complete InterQual medical reviews automatically, instantly, and accurately.

    iTraycer is a comprehensive inventory management system designed to provide real-time medical device tracking, as well as biologics tracking.

    Jembi Health Systems (Jembi) is an African-based not-for-profit company based in South Africa focusing on the development of eHealth and health Information systems in developing countries. The idea for Jembi grew out of the Open Architectures and Standards in Information Systems (OASIS) project, funded by the Canadian International Development Research Center (IDRC) and awarded to the South African Medical Research Council (MRC) in 2007

    Lightbeam helps your care management operations by providing a custom model that fits your needs and strategy. Lightbeam provides a set of activities to improve patient care and reduce the need for costly medical services by helping patients and caregivers more effectively manage health conditions.

    MedCompass is a fully integrated, outcome-driven solution that allows you to improve patient experience and quality of care and reduce costs to achieve the Triple Aim, while also enhancing the work life of healthcare providers.

    Envolve MSO services provide organizations with the strategies, people and processes necessary to provide value-based, affordable care and drive real healthcare transformation.

    MyOutcomes is a web-based clinical tool for improving outcomes and generating reports on client progress and program effectiveness.

    Quantros Quality Management Solutions Suite to optimize quality data collection, processing, analysis, and submission for both chart-abstracted and electronic clinical quality measures, helping to focus on what most important improving patient care and maximizing reimbursement.

    Routinify helps aging adults live their best lives by combining the power of data and intuitive technology with a tried-and-true approach to care - centred around engagement, involvement and communication.

    Visually interact with data for easier insight into ambulatory surgery center or revenue cycle operations. Quickly access key performance indicators (KPIs) to analyze financial performance. Easily identify trends and analyze historical data to identify problem areas within an organization. is an online pharmacy in USA which provides online services for Branded Medicine with low price.

    Welltok Enrichment provides you with standardized, segmented, and scored data sets from our consumer database of 275 million individuals and 800 variables, including social determinants of health like food security, education, job status and more. Use this enriched data to gain a unique understanding and valuable insights into critical areas of your business. And, you can drive value from this data using our other products to make an even bigger impact.

    Traditionally, payers and providers have been at odds while managing healthcare utilization and spend - Cortex, our smart utilization platform powered by real-time predictive analytics, allows payers and providers to work together with the same information and the same analysis, optimizing outcomes for every person they serve - the patient, the member, the human. To learn more about how we can support your success, visit

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