A Blueprint for Transforming Utilization Management
This concise, practical blueprint helps UM, clinical operations, and medical management teams take back control.
- Best practices for improving turnaround times and reducing provider abrasion
Optimize the operational levers payers use to modernize UM workflows, increase transparency with providers, and improve compliance without adding administrative burden.
- Actionable strategies for insourcing or hybrid UM models
Understand where delegation creates friction and how leading plans structure internal teams in a hybrid oversight model.
- ROI modeling and readiness checklists to build your business case
Quantify the business case with financial impact modeling, capacity assumptions, staffing considerations, and operational readiness indicators to support internal alignment and executive approval.
Take the first step towards modernizing UM workflows
Delegated vendor models often limit visibility, introduce inconsistency, and constrain a health plan’s ability to control cost, monitor compliance, and foster provider trust. This blueprint provides the framework needed to evaluate whether insourcing – or a hybrid strategy – is right for your organization.