CLINICAL OPERATIONS
Why Healthcare Organizations 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
• Core Administration and Configuration (QNXT, Facets, HealthEdge)
• Medicare, Medicaid & D-SNP compliance
• Stars, HEDIS, CAHPS improvement initiatives
We understand the workflow bottlenecks, operational dependencies, and decision-timeliness pressures that slow operational performance.
Platform-Specific Expertise That Accelerates Performance
We work inside the tools your teams use — accelerating operational assessment, reducing implementation risk, and improving execution accuracy.
Our platform expertise includes:
• Jiva, TruCare, GuidingCare, Essette (UM/CM)
• Facets, QNXT, HealthEdge (Claims/Core Admin)
This helps us prevent implementation risk, reduce rework, and improve platform stability and operational performance.
Supporting Resource-Constrained Healthcare Organizations
Unlike firms focused solely on national carriers, we specialize in regional plans, provider-sponsored and emerging healthcare organizations, and public sector MCOs that face:
- Lean internal resources
- Complex compliance environments
- Rapid regulatory shifts
- Greater pressure to prove ROI on spend
We help organizations improve operational performance without adding unnecessary overhead or operational complexity.
WHAT WE DO IN CLINICAL OPERATIONS
Utilization Management (UM) Performance
• Reduce backlog and improve throughput
• Improve review-to-decision timeliness
• Strengthen documentation + compliance
• Align UM workflows with regulatory standards
• Stabilize + optimize UM platforms (Jiva, TruCare, Essette, GuidingCare)
Care Management (CM) Optimization
• Streamline CM workflows
• Improve assessment and care plan completion rates
• Increase member engagement efficiency
• Redesign staffing models to increase capacity
• Strengthen audit readiness (NCQA, CMS, Medicaid)
Appeals & Grievances Performance
• Improve cycle times
• Standardize templates + documentation
• Strengthen root-cause processes
• Reduce overturn risk
• Improve compliance with CMS, Medicaid, and state timelines
Delegated Oversight & Compliance Strengthening
• Improve oversight workflows
• Build structured monitoring processes
• Strengthen reporting + documentation
• Reduce corrective action risk
• Improve regulatory survey readiness
Clinical and IT Integration
• Optimize platform configuration for speed
• Fix workflow bottlenecks inside UM/CM tools
• Improve routing, queues, triggers, and reporting
• Reduce manual work and 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.