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Clinical & Regulatory Guidance

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

APPEALS & 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

QUALITY IMPROVEMENT

Partner with Impresiv Health 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

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

Ready to get started?

Contact us to learn more about our Clinical Service capabilities and expertise.

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