Care Management
Workflow Software

Care Management Workflow Software

Too many obstacles stand in the way of implementing a person-centered model of care. Complex workflows. A lack of coordination among medical, behavioral and community health organizations. Inadequate partner and patient engagement. No access to real-time, actionable data. An inability to identify gaps in care. And more.

GuidingCare® clears all of these obstacles with a complete Care Management workflow platform that offers both health plans and providers easy-to-use, next-generation data integration and workflow management tools that streamline workflows, facilitate coordination and collaboration, accelerate quality improvement, and promote provider and patient engagement.

Care management workflow | Healthedge

The GuidingCare Solution Suite


GuidingCare is a comprehensive solution for whole-person, patient-centered care, offering easy-to-use, next-generation data integration and workflow management solutions and tools. Our feature-rich solution suite is easy to integrate with existing systems and is highly configurable.

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GuidingCare Care Management

Our Care Management workflow software provides tools that help you operationalize an evidence-based, person-centered care management strategy for your populations.

GuidingCare Utilization Management

Our Utilization Management module supports the complete authorization lifecycle, including clinical guidelines and authorization management workflows.

GuidingCare Authorization Portal

This intuitive and comprehensive electronic tool eases the preauthorization, appeals and messaging process for your Utilization Management staff and the providers who interface with your plan.

GuidingCare Business Intelligence

Our Reporting & Business Intelligence module provides more than 50 standard reports to make ad hoc report-building and analysis simple and actionable.

GuidingCare Population Health

Our web-based care coordination application for provider partners incorporates gaps-in-care analytics that enables clinical staff to identify high-risk patients and potential health improvement opportunities.

GuidingCare Appeals & Grievances

Our Appeals & Grievances module streamlines and consolidates the entire appeals management process to help you meet regulatory demands for timely resolution and correspondence.


Additional Offerings

GuidingCare Rules Designer

Independently create, manage, and deploy business rules into your GuidingCare instances to automate workflows and decision-making.

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GuidingCare Medication Therapy Management

Enable pharmacists with a central location in which they can manage member medications and intervene to prevent potentially harmful outcomes.

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GuidingCare Pediatric Population Health

Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.

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GuidingSigns® Analytics

A clinical decision support system that transforms data into actionable insights for healthcare payers and providers.

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What is a care management system?

A care management system or software is a type of software technology that helps care managers, providers, and care teams work more efficiently and effectively. This technology pulls data from disparate systems or areas - such as claims, EHR, pharmacy, or others, into one platform to help users with workflow management and care coordination. Robust care management software systems also offer services for areas such as utilization management, provider authorizations, appeals and grievances, population health, business intellgience and analytics, and more.


“Elderplan specializes in intense, complex care management of our membership, and GuidingCare has done a fantastic job helping us support those care management goals as well as compliance goals.”

Craig Azoff, Senior Vice President of Health Plan Information Systems

"We're trying to walk that fine line. We recognize the providers are on the front lines of delivering high-quality care to our members, and we value that partnership with our providers. We wanted to help solve that problem, reduce that burden and make their lives better"

Ann Donnelly, Vice President, Care and Utilization Management
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