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

    G2 takes pride in showing unbiased reviews on user satisfaction in our ratings and reports. We do not allow paid placements in any of our ratings, rankings, or reports. Learn about our scoring methodologies.
    Sort By:
    Results: 65
    Adv. Filters
    (13)3.6 out of 5

    Swoop allows biopharma marketers to run highly-converting, transparent audience targeting campaigns with full privacy support and compliance.

    (23)3.9 out of 5

    As a trusted adviser, Greenway Health is fueling our customers’ success by delivering the innovative technology, quality services, and strategic partnership that help them grow profitably, remain compliant, work more efficiently, and improve patient outcomes. It starts with Intergy, the core of our ambulatory platform. This is your first step toward becoming a high-performing practice. Intergy is available as a hosted or on-premise EHR and practice management system. This cloud-based solution

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

    (2)3.3 out of 5

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

    (1)4.5 out of 5

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

    (1)4.0 out of 5

    Noom Inc., a leader in mobile health coaching, combines the power of technology with the empathy of real human coaches to deliver successful behavior change at scale. Nooms direct-to-consumer weight loss and exercise tracking mobile applications have reached more than 45 million users worldwide. Leveraging the success of their ground-breaking health and fitness programs,

    (1)5.0 out of 5

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

    (1)5.0 out of 5

    Our single, modular cloud-based platform empowers healthcare providers with Best in KLAS modules designed for better decision support, financial planning, and continuous improvement to drive margins. With over 20 years of experience, Strata Decision Technology offers healthcare organizations the gold standard for financial planning, analytics, and performance. StrataJazz is trusted by over 215 healthcare systems and 1,000 hospitals in the U.S.

    0 ratings

    InfectionWATCH is a comprehensive infection surveillance and antibiotic reporting system that expands surveillance capabilities, so you can easily comply with new regulations and free up time to focus on prevention, intervention and performance improvement.

    0 ratings

    ABILITY OPTIMIZE Analytics is your go-to resource for your agencys performance improvement needs. From organizational performance analysis to accurate validation for OASIS data, ABILITY has you covered.

    0 ratings

    AbleTo is a leading provider of virtual behavioral health care. Deep behavioral health insights and an integrated proprietary platform identifies and engages the right patients with the right support when and how they want it.

    0 ratings

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

    0 ratings

    AccuCare allows clinicians in substance abuse treatment and behavioral health to quickly and easily enter client information and track outcomes. The web-based system allows the database to be accessed from any computer with internet access, giving clinicians a centralized and integrated workflow.

    0 ratings

    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

    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

    (1)4.0 out of 5

    Arezzo is an active clinical decision support and pathway technology desgned to empower personalised care delivery at patient and population level.

    0 ratings

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

    (1)0.0 out of 5

    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.

    0 ratings

    A comprehensive solution that connects acute care providers, physician groups and ACOs with home health agencies to better manage patient outcomes, operations, clinical protocols and utilization.

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

    0 ratings

    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.

    0 ratings

    Improve patient health and earn additional revenue with CircleLink CarePlanManager

    0 ratings

    Collective Medical helps care teams collaborate to support their most vulnerable patientsthose whose needs cannot be met in any single care setting.

    0 ratings

    Health Risk Modeling platform for Insurance and Healthcare providers.

    0 ratings

    Eazy HMS is an web based hospital management software developed for different sizes of hospitals from 30 to 150 beds.

    0 ratings

    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

    0 ratings

    Getinge ia a Hospital Planning Platform for better managing and planning even large-scale hospital project.

    0 ratings

    0 ratings

    The HCS Gadget is a real-time, rules-driven, desktop notification system that alerts caregivers when certain thresholds are triggered. The HCS Gadget is unique in that it operates unobtrusively across workstations, whether or not all workstations are part of the health system’s electronic medical record (EMR).

    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.