Utilization Management Companies

Utilization management companies manage the cost of care, particularly in healthcare, evaluating the medical necessity, appropriateness, and efficiency of healthcare services.
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Conifer Health Solutions

Conifer Health Solutions

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Min. Group Size

1,000 eligible

Lives Serviced

1,500,000

Average Cost

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Our Utilization Management (UM) program is delivered by licensed UM Nurses and positions our clients to not only focus on cost containment, but also their members’ access to the right care, in the... Show More
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Telligen

Telligen

5.0 (2)
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Min. Group Size

500 eligible

Lives Serviced

600,000

Average Cost

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Telligen's Utilization Management program makes sure your members get the evidence-based medical care they need. Telligen's utilization management program is designed to:
-Ensure high quality care is delivered to those who medically... Show More
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Quantum Health

Quantum Health

4.5 (4)
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Min. Group Size

500 eligible

Lives Serviced

20,000,000

Average Cost

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Quantum Health's utilization management combines clinical expertise, provider collaboration and proactive guidance to help members receive appropriate, evidence-based care at the right time. Integrated with healthcare navigation and care coordination, our clinical teams... Show More
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ActiveHealth Management

ActiveHealth Management

4.0 (1)
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Min. Group Size

1,500 eligible

Lives Serviced

3,800,000

Average Cost

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ActiveHealth’s Utilization Management program underscores the importance of providing evidence-based healthcare services designed to safeguard optimal health outcomes while controlling costs. Our staff of registered nurses and physicians support both participants and their... Show More
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Vālenz Health

Vālenz Health

2.8 (1)
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Founded

2004

Employees

500

Funding Summary

None

Clients Your Size Clients Your Size

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About Vālenz Health

Vālenz (VAY-lens) Health® is the platform to simplify healthcare: the destination for members, employers, payers, and providers to reduce costs, improve quality, and elevate the healthcare experience.

Our mission? To optimize the cost, quality, and utilization of healthcare for everyone with a fully integrated solution suite that executes across the entire patient journey, from member experience to payment integrity, provider quality, and plan performance.

With America’s largest cost, quality and utilization dataset, we create greater transparency, flexibility, and cost containment — empowering members and customers with the information they need to engage early and... Show More
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HealthCheck360

HealthCheck360

4.3 (31)
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Founded

1994

Employees

210

Funding Summary

None

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About HealthCheck360

HealthCheck360 is a population health management company that helps employers improve health outcomes, enhance the employee experience, and reduce healthcare costs through an integrated approach to wellness, advocacy and navigation, condition management, and medical management services.

Built on more than 40 years of health plan experience, HealthCheck360 combines clinical expertise, personalized member support, data-driven insights, and technology to guide employees toward healthier behaviors, better healthcare decisions, and improved long-term outcomes. Through our myHC360+ platform and dedicated team of coaches, nurses, advocates, and health professionals, HealthCheck360 delivers a connected experience that helps employers identify risks, engage employees,... Show More
MedWatch, LLC

MedWatch, LLC

Reviews pending
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Min. Group Size

1 eligible

Lives Serviced

383,000

Average Cost

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Since 1988, MedWatch’s URAC-accredited Utilization Management has been continually evolving and provides a process that is both efficient and effective in identifying appropriateness of care and opportunities for significant cost savings. The precertification... Show More
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TurningPoint Healthcare Solutions

TurningPoint Healthcare Solutions

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Founded

2014

Employees

400

Funding Summary

1 Angel Round

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About TurningPoint Healthcare Solutions

TurningPoint Healthcare Solutions is a specialty condition management company serving more than 45 million covered lives nationwide across commercial, Medicare, and Medicaid populations. Founded in 2014, we partner with health plans to improve the safety, quality, and affordability of care in high-cost, high-variation surgical categories — including musculoskeletal, cardiology, spine, pain management, sleep, and ENT.
Our model is physician-led and subspecialty-matched. Rather than relying on automated denials or generic clinical criteria, TurningPoint applies fellowship-trained subspecialist review to high-complexity cases — the ones where variation is greatest and the cost of getting it wrong is highest. AI-driven decision support surfaces... Show More
League

League

5.0 (1)
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Min. Group Size

100 eligible

Lives Serviced

-

Average Cost

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Through partner(s). Show More
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ClaimChoice Administrators

ClaimChoice Administrators

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-

Lives Serviced

-

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ClaimChoice Utilization Management is designed to enhance healthcare outcomes, manage costs, and ensure the highest quality of care for patients. Our platform provides real-time insights and data-driven decision-making tools to streamline the utilization... Show More
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Healthboxed

Healthboxed

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Founded

2019

Employees

4

Funding Summary

Not Provided

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About Healthboxed

Each HealthBox includes a curated selection of wellness products that align with the client’s chosen wellness theme and may also feature custom-printed materials such as an EAP flyer, open enrollment information, or other wellness resources. Our themed boxes cover topics like Open Enrollment, Mental Health, Healthy Eating, Exercise, Stress Relief, and more, with all orders custom-priced based on the client’s wellness fund budget. The minimum budget is $22 per employee (all-inclusive, flat fee), though most clients allocate between $30–$60 per employee, and there is a minimum overall spend of $3,000 per order with no minimum quantity required. Boxes can be... Show More
Sharecare

Sharecare

4.1 (5)
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Min. Group Size

5,000 eligible

Lives Serviced

2,000,000

Average Cost

Average Cost is Locked

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Sharecare partners with American Health (AHH) for utilization management as part of our clinical advocacy solution. AHH's URAC-accredited utilization management program is based on: timely review and determination of clinical eligibility for coverage,... Show More
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Sterling Wellness Solutions, L.L.C.

Sterling Wellness Solutions, L.L.C.

3.1 (6)
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Founded

2001

Employees

50

Funding Summary

None

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About Sterling Wellness Solutions, L.L.C.

At Sterling Wellness Solutions, we believe that health and well-being are the foundation for a fulfilling life. Our total approach to employee wellbeing provides innovative and personalized solutions that empower individuals and organizations to achieve their health goals. We are committed to a holistic approach that considers the physical, mental, and emotional aspects of health, and we believe that preventive care is key to a healthy lifestyle. Our values of integrity, empathy, collaboration, and accountability guide us as we create a culture of wellness that inspires individuals to take control of their health. With our expertise and support, we strive... Show More
US-Rx Care

US-Rx Care

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Founded

01/2007

Employees

200

Funding Summary

Not Provided

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About US-Rx Care

In contrast to traditional PBM service providers, US-Rx Care operates with full transparency and without any conflicts of interest, backed up by ERISA-defined fiduciary commitments in our service contract. Our fiduciary pharmacy benefits management services deliver unprecedented drug cost savings to self-insured employers, union trusts, and health plans. Typical client savings range from 30%-50% in total drug and administrative cost versus their previous PBM service provider within the first 12 months of US-Rx Care service. Member out-of-pocket costs drop 30% or more also with no change in benefit design. Show More
Acentra Health (previously Kepro and CNSi)

Acentra Health (previously Kepro and CNSi)

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Min. Group Size

-

Lives Serviced

-

Average Cost

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Acentra Health’s Utilization Management program includes pre-certification review, continued stay review, retrospective review, internal and external appeals (IRO), and discharge planning services based on medical necessity, relevance of care, and appropriate level of... Show More
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AlbumHealth

AlbumHealth

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Founded

2013

Employees

0

Funding Summary

Angel Round

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About AlbumHealth

Album's vision has always been to support people with chronic disease by changing their behavior. Supported by over a decade of research and clinical outcomes, we set out to prove it in a large employer setting in 2015.....and did. Now we're engaging payers, providers , and employers in the critical discussion around how to support the highest cost portion of their population. Show More
Corporate Care Management

Corporate Care Management

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-

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-

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Corporate Care Management is URAC accredited in Health Utilization Management. Health Utilization Management (HUM) provided by CCM supports the delivery of quality medical care and patient safety by evaluating for medical necessity, appropriateness,... Show More
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Hines & Associates, Inc.

Hines & Associates, Inc.

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Min. Group Size

-

Lives Serviced

200,000

Average Cost

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Hines & Associates

Utilization Management

Key to both patient satisfaction and responsible cost-control, Hines’ trusted Utilization Management services ensure all medical services meet the highest industry standards: Show More
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Ilant Health

Ilant Health

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Min. Group Size

250 eligible

Lives Serviced

1,000

Average Cost

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Ilant's Metabolism Matters provides a better approach to utilization management by using a comprehensive, whole-person approach (medical, nutritional, emotional, social determinants) to match each individual to the treatment option (e.g., specific medication, surgery,... Show More
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PlanSource Benefits Administration, Inc.

PlanSource Benefits Administration, Inc.

3.4 (15)
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Founded

2008

Employees

650

Funding Summary

Not Provided

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About PlanSource Benefits Administration, Inc.

Founded in 2008, PlanSource is a benefits administration company on a mission to make it easier for people to choose, use, and manage benefits through engaging, AI-powered experiences. PlanSource solves even the most complex benefits challenges for thousands of customers by pairing a comprehensive suite of strategic administration services with a modern and highly configurable platform. Leading the market in meaningful integration of AI, PlanSource has an unmatched range of ecosystem connections that drive continual innovation and value to clients, partners, and consumers. Headquartered in Orlando, Florida, PlanSource supports more than 5 million consumers through partnerships with more than 3,400 employers... Show More

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