Best Web-Based Utilization Management Software of 2025

AssureCare, a privately-held healthcare technology company, provides innovative care management solutions for commercial and health and human service providers. AssureCare's flagship platform, MedCompass is used by healthcare providers across the United States to provide end-to-end care management for millions. MedCompass transforms healthcare management through streamlining workflows and automating processes. This allows care professionals to make better decisions and achieve lower costs and a significantly improved quality of care. AssureCare is a leader in the development of modular, seamless solutions that improve patient outcomes and reduce unnecessary costs associated with population health management.

Each record signifies an individual, and every data point holds the potential to significantly impact a person's life, representing an opportunity for understanding and action. Thus, our mission is to foster enhanced health outcomes by refining the management of health information. Over the past four decades, Ciox has played a pivotal role in transforming the healthcare sector through superior health information management and the seamless exchange of health data. Our extensive involvement with medical records spans various industries, empowering us to innovate workflows, enhance access to clinical information, and boost the precision and movement of health data. We assist our clients in safeguarding, organizing, and utilizing health information effectively to achieve improvements in operations, maximize revenue, and ensure better outcomes for patients. Additionally, Ciox HealthSource serves as a fully scalable clinical data platform that harnesses Artificial Intelligence to deliver higher-quality data, alleviate administrative tasks, and enhance financial performance. This integration of technology not only streamlines processes but also sets a new standard for excellence in health information management.

Envision a mobile tool designed to assist individuals undergoing treatment in a secure and user-friendly manner. Wouldn't it be incredible to connect a client’s professional team alongside their personal support system to enhance the chances of enduring treatment success? With Rallyest, you can provide clients with the best possible resources. We are excited to introduce video capabilities to our essential features. This innovative tool allows users to capture and share secure video content with clients, their support networks, and professional caregivers using either smartphones or computers. This functionality enhances confidential input, support, and connections for those in various treatment environments. By engaging clients and incorporating their support networks, we can significantly improve treatment outcomes for everyone involved. Rally a client’s extended network, consisting of trusted family members, friends, colleagues, clergy, and professionals, all in one place. Experience the convenience of having a centralized hub for a client’s photos, videos, updates, files, posts, comments, notifications, and announcements, fostering a comprehensive and cohesive support experience.

Connexall is a hospital-wide event management and control platform. It was ranked number one in the 2015/2016/2017 awards and 2018 Best in KLAS Awards. It acts as a backbone to clinical workflow by communicating the correct information to the right person at the right time on the right device. The Class II medical device software, based on more than 20 years worth of R&D, is completely vendor-neutral. Connexall has offices located in Canada, Brazil, Portugal, Hong Kong, and the United States. It works with more than a thousand of the most innovative and renowned hospitals and health systems around the globe.

A data-driven solution for managing claims and remittances specifically designed for healthcare providers looking to streamline their workflows, enhance resource efficiency, minimize denial rates, and expedite cash flow. Boost your initial claim acceptance rate significantly. Our all-inclusive edits package ensures you remain compliant with evolving payer guidelines and regulations. Increase your team's efficiency with user-friendly, exception-based workflows and automated procedures. Your personnel can conveniently utilize our adaptable, cloud-based platform from any device. Effectively manage your secondary claims volume through the automated creation of secondary claims and explanations of benefits (EOB) derived from the primary remittance advice. Leverage predictive artificial intelligence to identify and prioritize claims that require attention, allowing for quicker error resolution and minimizing denials before submission. Achieve a more efficient claims processing experience. Additionally, print and distribute primary paper claims, or compile and send collated claims along with EOBs for secondary submissions. This holistic approach not only enhances operational efficiency but also promotes better financial performance for healthcare providers.

Therap stands out as the foremost provider of electronic documentation and record-keeping solutions for long-term care services catering to individuals with Intellectual or Developmental Disabilities. This comprehensive web-based application suite is meticulously crafted to meet the diverse needs of organizations that assist these individuals, encompassing aspects such as planning, documentation, reporting, communication, and billing across various environments, including home and community-based services (HCBS). By leveraging secure cloud technology, the Therap system enhances service quality in settings like day programs, assisted living facilities, ICF/IID facilities, community support programs, and state agencies. It facilitates effortless daily communication and reporting among states, administrators, healthcare providers, case managers, quality assurance teams, and families, ensuring that everyone involved is well-informed and connected. Ultimately, Therap's innovative approach fosters a more coordinated and efficient support system for those with intellectual and developmental disabilities.

Since its inception in 1992, Orion has been dedicated to delivering technology solutions and professional services aimed at enhancing workflows within the addictions and mental health fields. The premier software offering from Orion, the cloud-based AccuCare EHR, was developed by a skilled team of clinicians and engineers focusing on optimizing essential aspects of agency operations, such as clinical care, financial management, billing, administrative tasks, and research analysis. AccuCare offers a comprehensive suite of features, including tailor-made screenings and assessments, admission and discharge processes, treatment planning, progress notes, telehealth services, e-prescribing capabilities, scheduling, electronic billing, and custom reporting functionalities. Additionally, the AccuCare Web-Based Practice Management System is backed by a team of dedicated specialists who are prepared to address any inquiries regarding system usage in relation to existing documentation and billing procedures. Included in the subscription are customer support services, as well as regular automatic updates and upgrades that incorporate real user feedback, ensuring that the software remains responsive to the needs of its users. This commitment to continuous improvement and user satisfaction highlights Orion's dedication to advancing the effectiveness of mental health and addiction services.

Effectively overseeing patient care requires a balanced mix of clinical expertise and technological tools. In a field often characterized by high labor demands, these tools should not only facilitate and improve care management processes but also enhance the financial health of the organization. AveCare offers a comprehensive solution that integrates care management functions—including care management (CM), disease management (DM), and utilization management (UM)—streamlining workflows and providing robust management capabilities at a competitive price point, enabling organizations to maximize both clinical and financial resources while elevating the quality of care and patient outcomes. The platform allows for the exchange of data from a variety of sources such as eligibility, claims, pharmacy, diagnostic tests, lab results, predictive analytics, decision support systems, and electronic faxing. Designed for integration, it seamlessly combines case management, disease management education, and utilization management functions into one cohesive system. Users can access a centralized view of all relevant CM, DM, and UM activities related to each patient, ensuring that care is coordinated and informed by comprehensive data. This holistic approach not only streamlines operations but also fosters better communication among healthcare providers.

VitalHub offers a suite of solutions focused on Patient Flow, Operational Visibility, and Patient Journey Optimization, specifically tailored for intricate hospital systems and integrated health settings. Our innovative technologies enable frontline staff, healthcare providers, and management to enhance the patient experience while achieving greater operational efficiency, ultimately leading to safer care outcomes. We provide tools that streamline various aspects of healthcare, including patient flow management, perioperative processes, demand and capacity planning, virtual consultations, clinic administration, and the overall patient journey. By enhancing transparency and communication, our solutions offer real-time visibility across the entire system, ensuring integrated information is available for coordinated care and optimizing patient transitions. Furthermore, VitalHub’s Electronic Health Record (EHR) offerings extend beyond conventional clinical data collection, delivering a comprehensive and holistic perspective of patients and clients right at the point of care, which fosters better decision-making and improved health outcomes. Through these advancements, we aim to transform healthcare delivery into a more efficient and patient-centered experience.

As technology advances and treatment options grow increasingly complex, the demand for cohesive solutions and access to information becomes vital. We stand by your side as a comprehensive partner throughout the clinical journey, enabling you to deliver exceptional care while maintaining the highest standards of quality and safety. Whether your focus is on creating today's treatments or pioneering tomorrow's breakthroughs, you will face the shared challenge of preventing contamination. Our commitment is to assist you in fostering a research or production environment that is both efficient and free from contaminants. To guarantee optimal performance, cutting-edge medical equipment requires a blend of intelligent financial strategies and proactive maintenance. We provide you with complete financial oversight and reassurance, permitting you to concentrate on the crucial mission of saving lives. As a top-tier medtech company, our dedicated team channels all talents and resources toward empowering our clients to maximize their life-saving potential. Ultimately, our goal is to ensure that your innovations can thrive in a safe and supportive atmosphere.

Transforming fragmented health data into meaningful insights is at the heart of what we do. Clarify Health's analytics platform cuts through the confusion, enabling organizations to excel in a post-pandemic landscape. We provide accurate insights into the performance of healthcare providers, the experiences of patients, and the adoption rates of therapies. With our state-of-the-art analytics software, you can confidently enhance physician performance, align patients with suitable care options, and adeptly manage value-based agreements. Harness insights that can expedite product launches and foster growth, while showcasing real-world effectiveness and facilitating outcomes-based contracts. Accurately pinpoint leading physicians and facilities, offer a more tailored experience to members, and optimize value-based interactions. Our timely insights are generated through a multitude of predictive models, organizing data into real-time analyses that drive measurable return on investment. Fueled by extensive data and cutting-edge technology, we are dedicated to transforming health data into tangible results that make a difference in patient care. In this rapidly evolving healthcare environment, our platform empowers stakeholders to make informed decisions that lead to better health outcomes.

Effective coordination of care, assessment of quality, risk identification, and compliance monitoring are all essential processes that rely on data from a variety of sources and systems, ultimately enhancing the experiences of both patients and providers. Midas Health Analytics offers innovative solutions designed to enhance operational and clinical effectiveness by managing risks, optimizing costs, and transforming data into practical insights. By monitoring and analyzing performance trends over time, organizations can proactively address and reduce risks, make informed decisions in the face of evolving regulations, and create a safe environment for patient care. Achieve unparalleled operational efficiency while assessing, interpreting, and presenting quality of care performance results to stakeholders, navigating the complexities of today's healthcare landscape. This approach not only improves accountability but also fosters a culture of continuous improvement within healthcare organizations.

Numerous healthcare facilities, including hospitals and ambulatory surgery centers (ASCs), face considerable challenges in documenting procedures effectively. The diverse methods used by physicians for documentation—such as dictation, transcription, and electronic medical records (EMRs)—often lack uniformity, resulting in procedure notes that may be inaccurate, incomplete, or fail to meet compliance standards. Consequently, these reports tend to be unsearchable and difficult to analyze due to their reliance on unstructured data. Furthermore, inefficient workflows contribute to financial setbacks and increased frustration among physicians. To address these issues, a solution is proposed that guides physicians through an intuitive workflow navigation tree, which facilitates quick documentation by providing appropriate options. This system also aids organizations in achieving quality and compliance benchmarks by enabling users to generate over 100 reports and analyze structured data effectively. Additionally, it connects seamlessly with endoscopy scopes, allowing for the collection of relevant images that can be incorporated into procedure notes, ultimately enhancing the overall documentation process. This integrated approach not only streamlines documentation but also improves patient care by ensuring thorough and accurate records.

Enhance the effectiveness of your organization and streamline the validation process of OASIS data using cloud-based reporting and analytics tools tailored for home health services. By equipping home health agencies with the means to pinpoint actionable insights, you can elevate patient outcomes and star ratings, decrease readmission rates, enhance referral rates, and ultimately boost your revenue streams. OASIS Intelligence serves as the essential platform for addressing your home health agency's needs in performance improvement. Our cloud-based software not only facilitates thorough analysis of organizational performance but also ensures swift and precise validation of OASIS data. With access to the latest data, you can uncover performance trends and identify areas for improvement, leading to quicker enhancements in your processes and increased star ratings. Stay informed about quality standards and reimbursement accuracy through automated notifications that alert you to any errors or discrepancies in the OASIS documentation. Our reporting capabilities are comprehensive and adaptable, allowing you to examine everything from monthly performance trends and condition-specific evaluations to detailed patient-level outcomes. By leveraging these insights, your agency can strategically target areas for growth and improvement, ultimately driving better health outcomes for your patients.

CORTEX represents a groundbreaking advancement in utilization management software, delivering a comprehensive 360° solution to navigate the complexities of utilization management and revenue cycle operations. Powered by an advanced machine learning engine and real-time predictive analytics, CORTEX guarantees that cases are addressed promptly and appropriately, whether by the right personnel or through exceptions. By integrating precision medicine with a robust foundation of evidence-based practices, CORTEX enhances the evaluation of patient populations through real-time machine learning models. Our analytics solutions have been successfully implemented in hospitals and health plans nationwide, demonstrating their effectiveness. For straightforward inpatient cases, CORTEX streamlines the process by automating determinations based on your specific criteria, significantly reducing the burden on staff. In contrast, when facing challenging cases, CORTEX equips your team with critical insights to facilitate well-informed decisions. This innovative approach delivers tremendous benefits to both payers and providers, fostering improved healthcare outcomes and operational efficiency. Furthermore, CORTEX's adaptability allows it to evolve with the changing needs of the healthcare landscape, ensuring sustained value over time.

Harnessing the capabilities of Medius’ multi-cloud AI platform enables an impressive accuracy and coverage rate exceeding 90% in health intelligence and risk predictions, utilizing only a handful of health variables. By analyzing a limited set of health data points, Medius’ platform efficiently aggregates and mines extensive datasets to produce vital health risk and underwriting insights in mere seconds, achieving remarkable accuracy and coverage that supports providers and payers in their assessments, operational efficiency, and cost-saving strategies. Furthermore, Medius’ proprietary UW Studio™ serves as a comprehensive underwriting platform that revolutionizes the insurance industry, employing various science-driven underwriting ensemble models to meet both business and technical needs, while emulating human-like actuarial reasoning with clinical precision. This innovative approach not only streamlines decision-making processes but also enhances the overall effectiveness of health insurance operations.

We offer privacy-conscious DTC and HCP segments that excel in audience quality and yield significantly better results than traditional targeting methods. Recognizing that each therapy and brand possesses its own unique qualities, we do not subscribe to the conventional condition-based segmentation approach. Our focus is on comprehending your specific challenges and business objectives to create tailored audiences that effectively address your needs. Whether you are an established market leader, a newcomer grappling with adherence issues, or strategizing to promote multiple products, our expertise can help you achieve measurable outcomes. We uphold the highest industry standards for performance metrics, as verified by independent sources. Furthermore, if you provide us with your Audience Quality (AQ) benchmark at the outset, we commit to meeting or surpassing it. Enhanced AQ translates to increased engagement, improved conversion rates, and ultimately greater script lift, while also enhancing therapy adherence and maximizing patient lifetime value. Our operations strictly adhere to all applicable laws, regulations, and guidelines to ensure complete compliance. Partner with us to transform your audience strategies and drive exceptional results in your marketing efforts.

InterQual® AutoReview is a cloud-based solution designed for healthcare providers aiming to leverage artificial intelligence to analyze real-time data from electronic health records (EHR) for personalized predictions and proactive insights, while seamlessly automating the InterQual® medical review process. By integrating with current workflows, InterQual AutoReview alleviates administrative pressures by automatically fulfilling InterQual medical review requirements using EHR data. This innovative tool enhances the credibility of medical reviews by ensuring they are precise and transparent, incorporating embedded EHR information for each criterion point outlined in the InterQual guidelines. Additionally, this system fosters greater collaboration between providers and payers, ultimately leading to improved patient care outcomes.

Designed specifically for behavioral health organizations, our team is deeply committed to aiding individuals on their recovery journey. We have the privilege of collaborating with some of the finest sober living facilities and recovery coaches in the industry. By equipping these programs with essential digital tools, we enable them to implement data-driven strategies that effectively cater to their clients' needs. Our software is crafted to empower sober living homes, drug courts, recovery coaches, and treatment centers in delivering top-tier services to those they assist. Our unwavering mission is to support the organizations that devote their lives to guiding others through recovery. We aim to streamline your operations by automating the various manual processes associated with managing a behavioral health organization. By utilizing our comprehensive system, you can enhance client support and simplify program management. Moreover, our solutions are designed to boost your revenue and increase referrals, ensuring your organization thrives in its vital mission. Through our partnership, we aspire to elevate the level of care and support available to those in need.

Acuity Advanced Care™ is a flexible on-premise population health platform tailored to meet the varied requirements of case, utilization, disease, and overall population health management initiatives. This system empowers organizations by granting them complete control over their environment while allowing for customization to cater to each entity's distinctive care strategies. Impressively, over 90% of Acuity Advanced clients hold either NCQA or URAC accreditation, or both. With Acuity Advanced Care, users benefit from the inherent flexibility that an on-premise solution provides, along with comprehensive database access. The on-premise setup enables organizations to dictate the location of their data storage. Those clients who possess skilled IT teams are capable of handling the configuration, security, and upkeep of intricate systems independently. Chordline Health stands out as a premier software provider focused on assisting health plans, TPAs, ACOs, and various risk-bearing entities. The skilled team at Chordline, composed of US-based clinicians and developers, is celebrated for its unparalleled expertise in managed care and exceptional customer service, ensuring that clients receive top-tier support and solutions for their healthcare needs.

Our innovative virtual therapy and coaching services are designed to alleviate stress, anxiety, and depression, while our accessible self-care resources empower you to cultivate resilience and navigate daily hurdles. By employing evidence-based methods, you will acquire skills to effectively manage your emotions and gain a sense of control in the face of life's challenges. Tailored cognitive behavioral therapy programs, crafted by top mental health experts, ensure that your experience is both personalized and effective. We utilize predictive analytics to identify individuals requiring assistance, thereby enhancing engagement through targeted marketing strategies. With our advanced technology platform, clinicians can optimize costs by aligning members with the most appropriate treatments for their needs. AbleTo’s integration into your health plan’s current care framework is seamless, providing the assurance that you are only charged when our services yield tangible benefits. Additionally, our commitment to continuous improvement ensures that we adapt to your evolving needs over time.

Forge deep and impactful connections with individuals using a premier digital-first platform. Achieve wellness visit rates that exceed the national average annually. Icario operates as a health action enterprise, meaning you only incur costs based on actual results. By leveraging comprehensive data about the whole person, behavioral insights, and a variety of digital engagement channels, Icario enables you to establish personal connections effectively. We understand individual preferences for interaction and the motivations that inspire them to take health-related actions. As individuals make proactive health choices, healthcare organizations also experience significant improvements. Icario integrates your data with ours to develop a holistic view of individuals, transforming mere data points into real, relatable people. Our unique research on behavior, combined with quantitative analysis, enhances your understanding of individuals from a clinical standpoint to a more personal level. Tailored, smart pathways ensure that the most appropriate messages and outreach strategies are delivered to each person, ultimately encouraging the desired health behaviors. With Icario, you’re not just engaging with data; you’re cultivating relationships that foster better health outcomes for everyone involved.

Specialty and rare diseases often encompass patient populations that are not clearly defined, including individuals who remain undiagnosed or face misdiagnoses, along with healthcare providers who may lack knowledge about these conditions and their various manifestations, resulting in treatment pathways that are poorly understood. IPM.ai operates as an Insights-as-a-Service (IaaS) firm, dedicated to empowering leading life sciences organizations to gain deeper insights into patient care and enhance the quality of life for those affected through the development, clinical research, and commercialization of therapeutic solutions. By predicting market size, analyzing the competitive landscape, and estimating potential return on investment, companies can optimize their commercialization strategies. Additionally, the platform identifies undiagnosed and misdiagnosed individuals who could benefit from early disease interception and therapeutic measures. It employs statistical models to gauge the prevalence of specific diseases within certain patient populations at any given moment. Furthermore, IPM.ai helps pinpoint physicians who are adept at diagnosing and treating these ideal patients, while also influencing other healthcare providers to enhance overall patient outcomes. This comprehensive approach ultimately aims to bridge the gap in understanding and addressing the needs of those with rare diseases.

The SMAF tools have been consolidated into a single, shareable information system, enabling automated calculations of SMAF profiles. This system offers reports that aid in analyzing results and creating assistance plans, making it straightforward for healthcare professionals to use. Additionally, it enhances networking and service organization without requiring any software installation. The iSMAF, marking the fifth significant version of our software, operates as web-based software that digitizes established clinical tools and processes linked to the SMAF tool. Specifically designed for Quebec, the iSMAF edition features the PRISMA-7, the SMAF evaluation grid, the social-SMAF, a generator for Iso-SMAF profiles, and a care table. Furthermore, it provides various functions that allow clinicians and managers to produce reports on specific subjects or groups, facilitating a comprehensive understanding of the establishment, the progression of profiles over time, or comparisons between different groups based on their profiles. This integration represents a significant advancement in streamlining the management of health assessments and planning.

We collaborate with governmental bodies and humanitarian organizations to create health information systems that prioritize human needs and are open-sourced. By extracting valuable insights, we empower health workers, decision-makers, and patients throughout Africa. Our expertise lies in digital health information systems tailored for low-resource settings across the continent. We concentrate on both enterprise software and hardware for healthcare facilities. Our process encompasses everything from initial design and development to implementation, training, and ongoing support. Looking ahead, we aim to incorporate data analysis for better management of scarce resources. We firmly believe that strong health systems, coupled with the sharing of crucial information, can significantly enhance global health outcomes. Our approach involves strengthening local health systems by engaging communities to address their specific needs. We are dedicated to investing in and creating systems that are accessible for low-income nations, thereby helping to build their capabilities for self-sustained solutions. As an African non-profit organization, we are committed to improving global health through the development of information systems, fostering partnerships, and enhancing local capacity, ultimately striving for a healthier future for all. By nurturing local expertise, we ensure that solutions are not only effective but also sustainable in the long term.