Clinical Edge Care Management
Care Management, part of Clinical Edge, replaces siloed systems with connected, evidence-based workflows so care teams deliver person-centered care that improves outcomes.
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Advanced Care Coordination
Connect multidisciplinary care teams to prioritize interventions and close care gaps, so every member's needs are addressed efficiently across the care spectrum.
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Multidisciplinary team coordination
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Prioritized worklists and interventions
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Streamlined care gap closure
Automated Care Planning
Automation draws on assessments and a broad range of member data to proactively build and sustain a comprehensive, whole-person care plan for each member.
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Data-driven care plans
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Automated updates
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Evidence-based logic
Community Referrals and Mobile Clinician
Connect members to community social services and equip field clinicians with mobile access to assessments and care plans, online or offline.
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Social services integration
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Closed-loop referrals
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SDOH support
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Offline mobile field access
Clinical Edge Suite
Care
Management
Streamlined workflows and centralized member data help care teams deliver personalized, evidence-based, whole-person care.
Utilization
Management
Clinically sound, workflow-driven tools with intelligent automation optimize the authorization lifecycle and support compliance.
Appeals
and Grievances
An intuitive, end-to-end solution consolidates appeals, supports regulatory compliance, and delivers one-click packet creation.
Authorization
Portal
End-to-end workflows, automated approvals, and real-time provider communications that boost operational agility across your plan.
Mobile
Clinician
Secure mobile access lets field staff run assessments, build care plans, capture consent, and start referrals online or offline.
Member
Engagement
A scalable digital platform pairs omnichannel communication with advanced tools to deliver measurable health outcomes.
Population
Health
Real-time analytics and effective stratification identify at-risk populations and help your teams close care gaps faster.
Quality360
NCQA-certified quality management links HEDIS gap identification to care workflows, streamlining closure and reducing manual work.
Business Intelligence
Advanced reporting and dashboards for CMS and NCQA give your teams the insight to drive smarter, data-backed decisions.
Clinical Edge University
24/7 access to module-based training, so staff can build product expertise on their own schedule, from anywhere.
Deep Clinical Expertise
Clinical Edge pairs the most widely adopted care management platform with a seasoned clinical team that bridges clinical and technical domains.