CLINICAL OPERATIONS PERFORMANCE

Expert-Led Strategy. Real-World Execution.

Impresiv Health helps health plans deliver faster decisions, stronger compliance, and better member outcomes—powered by clinical, operational, and technology specialists.

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Why Health Plans Choose Impresiv

Deep Understanding of Health Plan Operations

We understand how health plans actually run — and where the operational friction lives. Our team brings hands-on expertise across:

• Utilization Management (UM), Case Management (CM), Behavioral Health (BH)
• Appeals & Grievances operations
• Claims + Configuration (QNXT, Facets, HealthEdge, etc.)
• Medicare, Medicaid & D-SNP compliance
• Stars, HEDIS, CAHPS improvement initiatives

We understand workflow bottlenecks, decision timeliness, and the operational levers that improve performance.

Platform-Specific Expertise That Accelerates Performance

We work inside the tools your teams use — making discovery faster and execution more accurate. Our platform expertise includes:

• Jiva, TruCare, GuidingCare, Essette (UM/CM)
• Facets, QNXT, HealthEdge (Claims/Core Admin)

This helps us prevent vendor missteps, reduce rework, and optimize configurations immediately.

Specialists in Regional & Government Plans

Unlike firms focused solely on national carriers, we specialize in regional plans, startup MAOs, and public sector MCOs that face:

  • Lean internal resources
  • Complex compliance environments
  • Rapid regulatory shifts
  • Greater pressure to prove ROI on spend

We help these plans do more with less—without compromising member outcomes or compliance.

WHAT WE DO IN CLINICAL OPERATIONS

1. Utilization Management (UM) Performance

• Reduce backlog + improve throughput
• Improve review-to-decision timeliness
• Strengthen documentation + compliance
• Align UM workflows with regulatory standards
• Stabilize + optimize UM platforms (Jiva, TruCare, Essette, GuidingCare)

2. Care Management (CM) Optimization

• Streamline CM workflows
• Improve assessment + care plan completion rates
• Increase member engagement efficiency
• Redesign staffing models to increase capacity
• Strengthen audit readiness (NCQA, CMS, Medicaid)

3. Appeals & Grievances Performance

• Improve cycle times
• Standardize templates + documentation
• Strengthen root-cause processes
• Reduce overturn risk
• Improve compliance with CMS, Medicaid, and state timelines

4. Delegated Oversight & Compliance Strengthening

• Improve oversight workflows
• Build structured monitoring processes
• Strengthen reporting + documentation
• Reduce corrective action risk
• Improve regulatory survey readiness

5. Clinical + IT Integration

• Optimize platform configuration for speed
• Fix workflow bottlenecks inside UM/CM tools
• Improve routing, queues, triggers, and reporting
• Reduce manual work + duplicated tasks
• Align technology with clinical operations

Get In Touch

Tell us what performance challenges you’re looking to solve.

If you have questions, feel free to contact us at 1.888.208.6753 — we’re here to help.

Most health plans reach out when they’re facing backlogs, compliance pressure, workflow bottlenecks, platform issues, or simply need more capacity. A short conversation can help us understand what’s happening and identify the fastest path forward.

How we can support you:

  • Speak directly with a clinical operations expert

  • Request a UM/CM performance assessment

  • Start with a 20-minute discovery call to explore your needs