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 program is delivered by licensed Utilization Management 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 (1)
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Min. Group Size

500 eligible

Lives Serviced

3,100,000

Average Cost

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Quantum Health delivers utilization management through dedicated Pre-Certification and Utilization Review Nurses embedded in each Pod. Pre-certification acts as an early touchpoint, enabling proactive engagement for care coordination, case management, and in-network redirection.... Show More
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Personify Health

Personify Health

4.0 (98)
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1,000 eligible

Lives Serviced

-

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Personify Health’s URAC-accredited Utilization Management Department performs prior authorization/precertification reviews to ensure medical necessity. We offer a customizable prior authorization/precertification list that can be personalized to clients' needs.

Clinicians also... 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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Inclusively

Inclusively

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-

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Inclusively’s Retain platform transforms everyday employee interactions with HR systems into powerful, anonymized insights. It maps what employees are actually searching for—benefits, wellness programs, services, technologies, accommodations—against what companies already offer, revealing gaps... Show More
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Wellworks For You

Wellworks For You

4.1 (40)
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Min. Group Size

50 eligible

Lives Serviced

139,500

Average Cost

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Not currently available with Wellworks For You. Show More
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HealthCheck360

HealthCheck360

4.4 (29)
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Founded

1994

Employees

210

Funding Summary

None

Clients Your Size Clients Your Size

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About HealthCheck360

At HealthCheck360, we turn our passion into your program. We’re leaders in population health management and well-being solutions. Our services are like a choose your own adventure book. Select the options you need to fill gaps in your current benefits or create a comprehensive program to fit your organization’s unique culture. We can even work with your brokers, third party administrator, insurance companies or other benefit provider for a complete integration of services. Show More
MedWatch, LLC

MedWatch, LLC

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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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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
League

League

5.0 (1)
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Min. Group Size

100 eligible

Lives Serviced

-

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Through partner(s). Show More
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ClaimChoice Administrators

ClaimChoice Administrators

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-

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-

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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

Clients Your Size Clients Your Size

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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
Milu Health

Milu Health

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-

Lives Serviced

-

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Milu's BenefitMatcher product identifies opportunities for employees to utilize existing employee benefits & notifies them in real time. Members will be notified when the opportunity to utilize a potential benefit is detected in... Show More
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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
AlbumHealth

AlbumHealth

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Founded

2013

Employees

0

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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

Hines

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Founded

Employees

0

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WellSky

WellSky

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Founded

1980

Employees

1,800

Funding Summary

Not Provided

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About WellSky

WellSky is a technology company leading the movement for intelligent, coordinated care worldwide. Our next-level software, analytics, and services power better outcomes and lower costs for stakeholders across the health and community care continuum. In today’s value-based care environment, WellSky helps providers, payers, health systems, and community organizations solve tough challenges, improve collaboration for growth, harness the power of data analytics, and achieve better outcomes by further connecting clinical and social care.

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PlanSource Benefits Administration, Inc.

PlanSource Benefits Administration, Inc.

3.2 (11)
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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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