Reclaim Control of Utilization Management

Reclaim Control of

Utilization Management

Health plans are increasingly moving away from outsourced and delegated UM models, and for good reason. Discover how leading health plans are realigning operations, improving turnaround times, and reducing provider abrasion by bringing prior authorization workflows back in-house.

A Blueprint for Transforming Utilization Management

This concise, practical blueprint helps UM, clinical operations, and medical management teams take back control by providing:

Actionable strategies for insourcing or hybrid UM models
Understand where delegation creates friction and how leading plans structure internal teams in a hybrid oversight model.
ROI modeling and readiness checklists to build your business case
Quantify the business case with financial impact modeling, capacity assumptions, staffing considerations, and operational readiness indicators to support internal alignment and executive approval.
Best practices for improving turnaround times and reducing provider abrasion
Optimize the operational levers payers use to modernize UM workflows, increase transparency with providers, and improve compliance without adding administrative burden.

A Blueprint for Transforming Utilization Management

This concise, practical blueprint helps UM, clinical operations, and medical management teams take back control by providing:

Actionable strategies for insourcing or hybrid UM models
Understand where delegation creates friction and how leading plans structure internal teams in a hybrid oversight model.
ROI modeling and readiness checklists to build your business case
Quantify the business case with financial impact modeling, capacity assumptions, staffing considerations, and operational readiness indicators to support internal alignment and executive approval.
Best practices for improving turnaround times and reducing provider abrasion
Optimize the operational levers payers use to modernize UM workflows, increase transparency with providers, and improve compliance without adding administrative burden.

Delegated vendor models often limit visibility, introduce inconsistency, and constrain a health plan’s ability to control cost, monitor compliance,

and foster provider trust. This blueprint provides the framework needed to evaluate whether insourcing - or a hybrid strategy -

is right for your organization.

Take Back Control

of Your UM Workflow

Get the insights you need to improve compliance, elevate member experience, and regain operational control.

Availity is the trusted partner for organizations seeking to realize the greatest value from clinical, administrative, and financial data. Positioned at the nexus of provider, health plan, and consumer health information, Availity develops scalable, innovative solutions for healthcare data acquisition, standardization, transparency, automation, and exchange among health plans, providers, and technology partners. As one of the nation's largest health information networks, Availity facilitates billions of clinical, administrative, and financial transactions annually. Our suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment. 