Smarter clinical operations for a healthcare system that demands more
Health plans are under pressure to improve care, meet regulations and manage operations efficiently—all while navigating complex, resource-heavy workflows. Carelon Global Solutions brings together clinical expertise and smart technology to streamline complexity, accelerate care decisions and improve cost, quality and experience across the member journey.
Efficiency that delivers better health
We help health plans reduce medical costs and administrative overhead by streamlining clinical workflows and delivering scalable nurse capacity.
- Prior authorization intake, routing and triage
- Scalable qualified nurse workforce
- Clinical operations support across utilization management, population health, appeals and payment integrity
Streamlining decisions for stronger care delivery
We help ensure timely, high-quality care by guiding clinical decisions that connect members to the right services at the right time.
- Nurse-led outreach for post-discharge and chronic condition management
- Faster approvals and fewer denials through digital decision workflows
- Member-centered programs that improve STARS and close care gaps
Modernizing clinical delivery with every workflow
We strengthen clinical service delivery by empowering teams with training, automation and real-time insights.
- Proprietary nurse training program
- Digital trage tools that improve accuracy and reduce delays
- Quality review dashboards and process feedback loops
Sustained performance, delivered at scale
Our robust clinical knowledge combined with operational excellence ensures that we're able to support better care delivery for every member.
100%
accuracy across member touchpoints
130K+
prior authorizations reviewed per month
550+
highly skilled USRNs and PHRNs on staff
10%
reduction in average request handle time
