Clinical Edge
Utilization Management
Utilization Management, part of Clinical Edge, streamlines authorization workflows and improves care delivery — combining clinically sound automation with ecosystem integration.
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Comprehensive Workflows
Optimize the entire utilization management process with clinically sound, automated workflows.
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End-to-end UM workflows
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Automation built in
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Reduced administrative burden
Evidence-Based Decision Making
Integrate seamlessly with MCG Cite AutoAuth and InterQual™ Connect for evidence-based decisions.
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MCG & InterQual integration
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Consistent decisions
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Faster approvals
Ecosystem Integration
Connect Utilization Management to your existing systems for one connected view of care.
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Unified stakeholder access
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Real-time authorization tracking
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Connected data ecosystem
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 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.
Seamless Authorizations, Better Outcomes
ClinicalEdge Utilization Management speeds authorization decisions while reducing administrative burden for health plans.