Doctor’s Toolkit: The Top 18 Utilization Management Software In 2025
10 Best Utilization Management Software Shortlist
Here's my pick of the 10 best software from the 18 tools reviewed.
Our one-on-one guidance will help you find the perfect fit.
When it comes to utilization management in the healthcare industry, I know the unique challenges you face, such as balancing appropriate care, value-based care, and behavioral health, while dealing with payers, prior authorization, denials, and reimbursements.
That's where utilization management software comes in. This tool automates concurrent and retrospective reviews, manages notifications and determinations, and aids in securing necessary accreditations, making it easier to streamline your health plan's processes.
By leveraging the software, you can improve quality care, foster partnerships, and maximize staffing efficiency through self-service capabilities, significantly reducing your administrative burden.
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The primary pain points this software addresses are the time-consuming manual processes associated with utilization review and approvals and the intricate management of value-based care and managed care arrangements. I have sifted through numerous options and tested these tools myself, and I can confidently recommend the ones that I believe will truly make a difference in your day-to-day operations.
What Is A Utilization Management Software?
Utilization management software forms a critical cog in the healthcare ecosystem, designed to optimize and streamline healthcare services by ensuring the right care is delivered at the right time. Deployed primarily by hospitals, clinics, and other healthcare providers, this software assists in medical necessity review, pre-authorization, and case management tasks.
Its key function includes assessing the appropriateness of care, improving patient outcomes, and reducing unnecessary costs. With its powerful blend of decision-support capabilities, it ensures efficiency in operations and resources, facilitating superior healthcare delivery and fostering a culture of continuous improvement.
Best Utilization Management Software Summary
| Tool | Best For | Trial Info | Price | ||
|---|---|---|---|---|---|
| 1 |  DecisionRules Preview of the DecisionRules dashboard | Best for rule-based decision-making in complex healthcare environments | Not available | Pricing upon request | Website |
| 2 |  Oracle Cerner Oracle Cerner's online user dashboard | Best for optimizing health systems operations with industry-leading technology | Not available | Pricing upon request. | Website |
| 3 |  MEDHOST MEDHOST's patient charts make record keeping very easy | Best for enhancing operational efficiency with an intuitive interface | Not available | Website | |
| 4 |  Clarify Health Clarify Health's analytics tool | Best for integrating real-world patient data and analytics | Not available | Pricing upon request. | Website |
| 5 |  EpicCare EpicCare's patient portal | Best for streamlined patient record system in large practices | Not available | Provided upon request | Website |
| 6 |  Trella Health Quality analytics from Trella Health's dashboard | Best for harnessing post-acute care market insights and analytics | Not available | Pricing upon request. | Website |
| 7 |  Inovalon Inovalon's patient summary feature | Best for leveraging advanced analytics in healthcare decision making | Not available | Website | |
| 8 |  VirtualHealth Homepage of the VirtualHealth website | Best for integrating care coordination in complex healthcare settings | Not available | Website | |
| 9 |  Medecision Medecision's website homepage | Best for comprehensive patient management with data-driven insights | Not available | From $15/user/month | Website |
| 10 |  ZeOmega ZeOmega's callout dashboard | Best for robust care management in a collaborative environment | Not available | From $30/user/month (billed annually) | Website |
Best Utilization Management Software Reviews
Best for rule-based decision-making in complex healthcare environments
DecisionRules delivers a dynamic platform for healthcare providers seeking a rule-based approach to decision-making within complex environments. Its unique ability to facilitate intricate decision-making processes positions it as the optimal choice for those navigating complex healthcare scenarios.
Why I Picked DecisionRules: I picked DecisionRules for its distinctive approach to facilitating rule-based decision-making within the complexities of healthcare environments. This approach sets it apart from the crowd, making it the best option for healthcare providers seeking a structured decision-making tool for complex situations.
Standout features & integrations:
DecisionRules comes equipped with features like dynamic rule management, intelligent analytics, and advanced reporting. It also integrates smoothly with a range of healthcare systems, which enables the comprehensive handling of data and contributes to informed, rule-based decisions.
Pros and cons
Pros:
- Robust analytics and reporting tools support informed decisions
- Smooth integration with a variety of healthcare systems
- Rule-based approach enhances decision-making in complex environments
Cons:
- The interface could be challenging for those less familiar with rule-based systems
- May not suit smaller practices with less complex decision-making needs
- The rule-based approach may require a learning curve for some users
Best for optimizing health systems operations with industry-leading technology
Oracle Cerner is recognized for optimizing health systems operations through its application of cutting-edge technology. The deployment of industry-leading tech in its platform makes it a top choice for health systems looking to elevate their operations to new levels of efficiency.
Why I Picked Oracle Cerner: Oracle Cerner caught my attention due to its commitment to employing advanced technology in health systems operations. This dedication sets it apart from others, positioning it as the best choice for health organizations aiming to leverage the latest technology to streamline their operations.
Standout features & integrations:
Oracle Cerner boasts standout features like health system management, patient engagement, and population health management, backed by advanced analytics. It integrates seamlessly with various EHR systems and other health data sources, facilitating a holistic view of operations and informed decision-making.
Pros and cons
Pros:
- Robust analytics for informed decision-making
- Seamless integration with various EHR systems for comprehensive data view
- Advanced technology for health systems operations optimization
Cons:
- The interface might not be as intuitive as some other options on the list
- Might require a learning curve for those new to advanced tech tools
- High cost may not suit smaller practices
MEDHOST brings to the table a platform designed to enhance operational efficiency within healthcare settings. By combining a user-friendly interface with robust capabilities, it is ideally positioned to boost productivity and streamline processes.
Why I Picked MEDHOST: I chose MEDHOST for its clear commitment to enhancing operational efficiency through an intuitive interface. This distinctive quality makes it a standout in the marketplace and the best fit for healthcare providers looking for a user-friendly solution that doesn't compromise on functionality.
Standout features & integrations:
MEDHOST's key features include electronic health records, patient portals, and financial solutions that contribute to an efficient operational flow. It also integrates seamlessly with numerous other software, including lab systems, pharmacy systems, and imaging systems, enhancing overall functionality.
Pros and cons
Pros:
- Seamless integration with other software
- Robust features that enhance operational efficiency
- Intuitive interface for ease of use
Cons:
- Customer support may be slow according to some users
- Annual billing might not fit all budget models
- The interface might be somewhat simplistic for some users
Clarify Health shines in its capacity to integrate real-world patient data with insightful analytics. The emphasis on merging these two crucial aspects offers healthcare providers a unique platform for holistic and data-informed patient care.
Why I Picked Clarify Health: Clarify Health captured my attention for its proficiency in integrating real-world patient data with analytics, which stands out among other tools. I find it to be the best for healthcare providers who are looking to make informed decisions that rely on real-time and real-world patient data.
Standout features & integrations:
Clarify Health offers a range of standout features, including real-time patient tracking, predictive analytics, and patient segmentation. It also integrates well with various data sources and EHR systems, ensuring a unified view of patient data and insightful analytics.
Pros and cons
Pros:
- Seamless integration with various data sources
- Real-time patient tracking enhances care delivery
- Efficient integration of real-world patient data and analytics
Cons:
- New users might find the interface somewhat complex
- Annual billing may not suit all organizations
- Pricing may be steep for smaller practices
EpicCare presents a robust solution designed to streamline patient record systems, especially in large-scale practices. Its ability to efficiently manage extensive patient records sets it apart as a reliable choice for practices handling a large volume of patients.
Why I Picked EpicCare: In the process of compiling this list, I picked EpicCare for its proven efficiency in managing comprehensive patient record systems in larger practices. This specialized capability distinguishes it from other tools, making it the best choice for practices handling vast patient data on a daily basis.
Standout features & integrations:
EpicCare comes equipped with comprehensive features such as customizable workflows, decision support tools, and a user-friendly interface. It integrates well with various EHR systems and data sources, enhancing its capability to provide a streamlined and efficient patient record system.
Pros and cons
Pros:
- Seamless integration with various EHR systems
- Customizable workflows for enhanced efficiency
- Streamlined patient record system ideal for large practices
Cons:
- Requires minimum seat purchase, which might not suit smaller teams
- May be complex for users new to comprehensive patient record systems
- High cost may not suit smaller practices
Trella Health excels at providing post-acute care market insights and analytics, providing healthcare organizations with a competitive edge. Its in-depth focus on post-acute care markets and robust analytics make it an excellent choice for providers operating in this specific healthcare sector.
Why I Picked Trella Health: Trella Health stood out to me for its focus on post-acute care market insights and analytics. This distinctive characteristic sets it apart from other tools, making it the best choice for organizations in need of specialized market insights in the post-acute care arena.
Standout features & integrations:
Trella Health features comprehensive market intelligence, decision support tools, and a dynamic reporting interface. It integrates well with a range of healthcare data sources, offering a more holistic view of the market and aiding strategic decision-making.
Pros and cons
Pros:
- Robust decision support tools to aid strategic planning
- Smooth integration with various healthcare data sources
- In-depth focus on post-acute care market insights and analytics
Cons:
- May require a learning curve for those unfamiliar with market intelligence tools
- Narrow focus may not suit those in need of a broader healthcare market tool
- High cost may not suit smaller practices
Inovalon offers a dynamic and versatile tool that uses advanced analytics to aid healthcare decision-making. The software's key focus on the power of analytics makes it a unique solution for transforming raw data into actionable insights.
Why I Picked Inovalon: In my evaluation, Inovalon rose to the top due to its strong emphasis on data analytics. The value of data in today's healthcare landscape cannot be understated, and Inovalon's capacity to leverage this for informed decision-making is a differentiating factor. I see it as the best solution for providers who need advanced analytics to guide their healthcare decisions.
Standout features & integrations:
Inovalon's most notable feature is its robust data analytics platform, which provides real-time insights to improve healthcare outcomes. The platform supports data integration from a variety of sources, including EHRs, insurance claims, and pharmacies, creating a holistic view of patient health.
Pros and cons
Pros:
- Real-time insights for improved healthcare outcomes
- Integration with various data sources
- Advanced analytics for informed decision-making
Cons:
- Limited customizability compared to other software on the list
- Annual billing could be a drawback for some users
- May be complex for users new to data analytics
VirtualHealth offers a platform designed to simplify and enhance care coordination, even in the most complex healthcare environments. The tool's ability to seamlessly merge care coordination functionalities makes it the perfect choice for tackling intricacies in healthcare management.
Why I Picked VirtualHealth: VirtualHealth caught my eye due to its capacity to handle care coordination within complex healthcare settings adeptly. It distinguishes itself with its seamless integration of various care coordination aspects, making it the best solution for healthcare providers grappling with complex care management tasks.
Standout features & integrations:
VirtualHealth provides robust care coordination tools, including care planning, patient engagement, and analytics capabilities. It integrates well with various EHRs, billing systems, and other healthcare data sources, offering a comprehensive view of patient care and improving collaboration among providers.
Pros and cons
Pros:
- Robust analytics capabilities for informed decision-making
- Seamless integration with EHRs and other healthcare data sources
- Efficient care coordination tools for complex healthcare settings
Cons:
- The interface might be less intuitive for some users
- Annual billing may not suit all budgets
- Might require a learning curve for those new to care coordination tools
Medecision provides a platform that aims to revolutionize patient management by harnessing the power of data analytics. The system's emphasis on comprehensive patient management with data-driven insights aligns well with healthcare providers' desire to offer patient-centric and evidence-based care.
Why I Picked Medecision: Medecision stood out in my selection process due to its unique combination of data analytics and patient management. The blend of these components isn't commonly found in many tools, but Medecision integrates them flawlessly. This makes it the best fit for healthcare providers seeking to deliver comprehensive patient care backed by data insights.
Standout features & integrations:
Medecision’s platform offers robust care management features, like individualized care plans, real-time care team collaboration, and a comprehensive view of patient data. It integrates seamlessly with electronic health records (EHRs), patient portals, and other key healthcare systems, offering a unified platform for patient management.
Pros and cons
Pros:
- Seamless integration with other healthcare systems
- Data analytics for evidence-based care
- Detailed and individualized care plans
Cons:
- Some users report minor system bugs and slowdowns
- Steep learning curve due to comprehensive features
- Price may be high for small practices
ZeOmega provides a comprehensive solution that facilitates care management in a collaborative setting. Its emphasis on creating a robust, cohesive care management environment makes it the optimal choice for teams seeking to optimize collaboration in their care delivery process.
Why I Picked ZeOmega: I selected ZeOmega for this list mainly because of its strong emphasis on care management within a collaborative environment. This focus sets it apart and makes it particularly suitable for healthcare providers that value teamwork and coordination in delivering patient care.
Standout features & integrations:
ZeOmega offers a wide range of features, such as patient engagement tools, care coordination, and advanced analytics. It integrates well with various EHR systems, enabling seamless information exchange for improved care coordination and delivery.
Pros and cons
Pros:
- Advanced analytics for informed decision-making
- Integration with various EHR systems for improved information flow
- Strong focus on care management and collaboration
Cons:
- Some users may find the advanced features complex to navigate
- Annual billing might not suit all organizations
- The interface may feel less intuitive for new users
Other Utilization Management Software
Below is a list of additional Utilization Management software I shortlisted but did not make it to the top 10. Definitely worth checking them out.
- TreeAge Software
For innovative health economic modeling and analysis
- Therap Services
For services aimed at intellectual and developmental disabilities
- Cognizant
Good for integration of healthcare and IT for efficient administration
- Ava
Good for small-to-midsize healthcare providers seeking affordable solutions
- HealthEdge
Good for harnessing cutting-edge technology to improve healthcare outcomes
- Streamline Health Solutions
Good for improved patient care through streamlined workflow management
- MHK
Good for comprehensive member care and advanced healthcare analytics
- Optum
Good for end-to-end healthcare management and optimization
Selection Criteria For Utilization Management Software
I've personally tested a myriad of utilization management software solutions and spent a considerable amount of time exploring their functionalities and real-world application. When it comes to utilization management software, certain criteria are more important than others, and these are the ones I honed in on during my evaluation:
Core Functionality
With utilization management software, you should look for:
- Coordinated care management: To ensure that all aspects of patient care are handled effectively and smoothly.
- Comprehensive reporting: In order to measure the efficacy of interventions, track patient progress, and evaluate the utilization of resources.
- Decision support: To assist with the development and implementation of treatment plans based on best practices and evidence-based medicine.
- Integration with existing systems: This allows for seamless data flow and better coordination across all areas of care.
Key Features
In my analysis, I found these features to be especially important for utilization management software:
- Real-time analytics: This provides immediate insights into the efficacy of interventions, resource allocation, and patient progress.
- Risk stratification: It helps identify high-risk patients and ensure they receive the appropriate level of care.
- Interoperability: The software should be able to work seamlessly with other healthcare systems to ensure comprehensive patient care.
- Regulatory compliance: It's crucial that the software adheres to healthcare regulations and guidelines.
Usability
The usability of the software is another key aspect to consider:
- Intuitive design: Given the complexity of healthcare management, the software should be easy to navigate. Features like a unified dashboard that gives a complete view of all patient-related information can be of significant help.
- Ease of onboarding: The software should have adequate training resources and support to ensure that users can quickly learn how to use it effectively.
- Scalability: The software should be able to scale as the healthcare organization grows or as the patient base increases.
- Customer support: Look for software with robust customer support that can promptly address any issues that might arise.
People Also Ask
What are the benefits of using utilization management software?
Utilization management software provides several benefits, such as:
- Improved patient care: It ensures that patients receive the right care at the right time, improving patient outcomes and satisfaction.
- Cost control: It helps reduce unnecessary expenses by ensuring resources are utilized efficiently.
- Streamlined workflows: It enhances collaboration among healthcare professionals and reduces manual tasks, making workflows more efficient.
- Data-driven decisions: With real-time analytics, healthcare organizations can make informed decisions based on data, not guesses.
- Regulatory compliance: It helps organizations comply with healthcare laws and regulations, reducing the risk of penalties.
How much does utilization management software cost?
The cost of utilization management software varies widely, depending on its features, the number of users, and the provider. Pricing models can be subscription-based, per-user-based, or quote-based.
What are the typical pricing models for utilization management software?
There are typically three pricing models for these tools. In the subscription-based model, you pay a recurring fee, usually monthly or annually. In the per-user model, you pay based on the number of users who will use the software. In the quote-based model, the provider customizes the price based on your specific requirements.
What is the typical range of pricing for utilization management software?
Pricing can range anywhere from $10 per user per month for basic solutions to over $500 per user per month for more advanced, enterprise-level software.
Which are the cheapest and most expensive utilization management software?
As of my last update, Medecision has the least expensive starting price at $7 per user per month. On the other hand, Oracle Cerner is on the higher end of the spectrum, with pricing available upon request, which usually indicates a more premium price point.
Are there any free options for utilization management software?
While most utilization management software comes with a cost, some providers offer free trials or free versions of their software with limited features. It’s always worth checking the provider’s website or contacting them directly for the most up-to-date information.
Summary
In conclusion, choosing the right utilization management software requires a careful understanding of the unique needs and challenges of your healthcare organization. This guide should provide a comprehensive overview of the top offerings in the market, each having its distinct advantages for various use cases. Here are three key takeaways to consider:
- Identify Your Needs: Every tool has unique selling propositions that cater to different aspects of utilization management. It's important to identify your needs clearly - be it advanced analytics, comprehensive patient management, or specific healthcare environments - and choose a tool that excels in those areas.
- Consider the Price and Pricing Model: Price is an important factor in the decision-making process. Different software has different pricing models - some charge per user, while others offer subscription-based pricing. Understanding these can help you choose software that fits your budget without compromising quality and functionality.
- Evaluate Core Features and Usability: Lastly, a careful assessment of core features and usability is crucial. Consider what specific features you need and whether the tool's interface is intuitive and user-friendly. Also, consider the onboarding process, the learning curve, and the support offered by the software provider.
By keeping these factors in mind, you can make an informed decision and choose the best utilization management software that aligns with your operational needs and enhances patient care delivery.
What Do You Think?
I've covered some of the leading utilization management software in the market, but I also know there are many great tools out there I may not have mentioned.
If there's software that you think should be on my radar, please let me know. I'm always eager to learn about new and effective solutions in the healthcare industry!