Digital Healthcare Operations: Digital utilization management
Payers rely on advanced technology to assess requested care
An effective utilization management program helps payers manage the cost of benefits while ensuring the most effective, efficient, and highest quality of care and outcomes for its members. Without automation and the right people in the right place, the review process can be cumbersome and time-consuming, prone to mistakes and leading to dissatisfaction from both patients and healthcare providers.
Case Study
A leading national healthcare insurer relied heavily on a large staff, yet consistently experienced a shortage of employees. They needed a partner with deep staffing capabilities and access to leading digital technology to maintain consistent business operations.
Through EXL’s proprietary Healthcare Academy, domain experts learned the skills necessary to deliver efficient and accurate services. This deep domain training and education provided by EXL accelerated efforts for Philippine-based nurses to obtain their US RN licensure. EXL eliminated the staffing shortage and ensured consistent business operations.
As a result, EXL eliminated the staffing shortage and ensured a streamlined operating process, which included results like:
About EXL Health
Our digital operations take standard utilization management operations to the next level by enabling UM workflows with right-sized staffing solutions and a variety of digital technologies, including machine learning, artificial intelligence, natural language processing, predictive analytics, and more. From automated utilization review intake functions, to streamlined clinical determination with approval and/or denial, our digital technologies eliminate manual interventions and time-consuming tasks.
Work with EXL Health and produce results that matter.
To learn more, visit https://www.exlservice.com/industries/health-and-life-sciences.