Care Management
Deliver whole-person care models by innovating data analysis for risk assessment, transparent reporting of outcomes, and effective engagement and communication strategies.
How We Help
- Innovative/Streamlined Processes
- Real-World Experience
- Structured Workflow Development
- Application of Best Practices
- Holistic Care Guidance
Utilization Review
Ensure healthcare services are being used appropriately and efficiently with innovative business rules, portal design, and automated authorization workflow processing.
We Offer
- Cross-departmental Alignment
- System Configuration Optimization
- Prior Authorization Optimization
- Streamlined Processes
- Elimination of Unnecessary Effort
Grievances
We implement state of the art workflow management tools for auditing and reporting to help meet regulatory requirements and accreditation standards.
We Specialize In
- Development/Adoption of Standards
- Strengthening Documentation
- Procedure, Process and Workflow design
- Solution Design & Implementation
- Regulatory Reporting Strategies
Care Transformation
Implement a clinical model scalable enough to meet the needs of commercial, Medicare, or Medicaid products and sustainable to exceed the ongoing regulatory requirements of CMS, NCQA, and URAC.
What We Do
- Care Management Solution Design & Implementation
- Design strategic roadmaps
- Align Implementations to key initiatives
- Employee Learning & Development
- Execute Rapid Deployment Strategies
- Develop Appropriate Staffing Models
Business Transformation
We Help With the Redesign of
- Program Descriptions
- Policy & Procedures
- Standard Operating Procedures
- Correspondence/ Letters
- Operational & Regulatory Reports
- Workflow & Automation Strategy
- Training & Development
- Stratification Techniques
Quality Improvement
Partner with Medh Solutions to drive reporting, workflow optimization, and quality improvement initiatives for HEDIS, CAHPS, NCQA, and CMS.
We Focus On
- Long Term Sustainable Improvement
- Delivering Tangible Results
- Supporting Audit Preparedness
- Development of Policies & Procedures
- Comprehensive Readiness Assessments
Population Helath Platforms
- GuidingCare - HealthEdge
- Jiva - ZeOmega
- TruCare - CaseNet
- Aerial -Medecision
- Care Prominence - MHK
- Clinical CareAdvance - TriZetto
- Symphony - Advantasure
Admin Systems
- Facets & QNXT by TriZetto
- HealthRules Payor
- Plexis HealthSystems
- FICO Rules Engine
Supported Positions
- Business & Config Analyst
- Reporting Analyst
- QA Analyst
- Enterprise Architect
- Solutions Architect
- Database Administrator
- IT Systems Administrator
- Program/Project Manager
- Trainer
- Integration Analyst
- Clinical Consultant
