Our Care Management affiliate, Communitas, provides high-touch, customized support to clients and members. Our Utilization Management, Care Management, and Member Advocacy & Navigation services were built in direct response to our clients' input to offer a new approach to proactively engage health plan participants.
NCQA Accredited
We have received a 3-Year National Committee for Quality Assurance (NCQA) Accreditation for our Case Management and Utilization Management Programs.
We adhere to their guidelines for medical necessity reviews, determinations, and stringent quality standards with exceptional turnaround times.
The Person on the Other Side of the Phone Makes a Difference
Our dedicated team — comprised of a medical director, health advisors, nurses, social workers, intake specialists, and analysts — interfaces with providers and members in support of our clients’ health plan.
Proactive Assessment & Outreach
We provide comprehensive data capture and transparency across all client-directed point solutions to drive impactful and proactive engagement.
Our Clinical Platform
We have a high-tech, directly owned technology platform for ultimate customization, flexibility, and real-time integration to provide a client-directed member experience.
Data Transparency
By partnering with the WebTPA, we have real-time accessibility to operational, financial, utilization, and clinical data to provide a foundation of transparency for identification, tracking, and measurement of all program components.
Case Manager Intervention
We have substantiated cost savings projections tied to interventions with the ability to identify and advise on future cost savings opportunities.
Our full range of care management capabilities help clients take care of their members, while managing the plan's bottom line.
Utilization Management
Case Management
Chronic Condition Management
Maternity Management
Early Cancer Detection and Outreach
Health Coaching
Health and Wellness Programs
Population Health Management
Data Reporting and Analytics
Pre-Post Hospitalization Counseling & Support
Specialty Rx Management
OnSIGHT Health