Utilization Management Services
Right care. Right time. Right setting.
Strengthen utilization oversight with Sagility’s Utilization Management Services. Clinical expertise and tech-led workflows help health plans ensure medical necessity, manage length of stay, and optimize care delivery across various settings.
Overview
As part of Sagility’s Payer Clinical Services suite, our Utilization Management Services support prospective, concurrent, and retrospective reviews across medical and pharmacy services. We partner with health plans to apply evidence-based criteria, manage length of stay, and oversee appropriate care progression after care begins — balancing cost containment, compliance, and member outcomes at scale.
Prospective, Concurrent, and Retrospective Review
- Prospective medical necessity review for scheduled services
- Inpatient and outpatient concurrent review
- Continued stay and level-of-care assessments
- Retrospective utilization review and variance analysis
Clinical Decision Support and Oversight
- Application of evidence-based clinical criteria
- Nurse and physician clinical review
- Peer-to-peer coordination and escalations
- Audit-ready documentation and compliance support
- Peer-to-peer coordination and escalations
Utilization Optimization and Performance Insights
- Identification of avoidable or inappropriate utilization
- Length-of-stay management and trend analysis
- Collaboration with care management and provider teams
- Scalable support for census fluctuations and regulatory changes
Our Accreditations
Industry-recognized certifications that demonstrate our commitment to quality, security, and excellence.
Straight from the Source
We’re more than a vendor, we’re a partner. Here’s what our clients have to say:
I love working with the Sagility team. They are professional, caring, and always willing to help wherever needed. They deliver high-quality work promptly and consistently exceed expectations.
Senior Payment Integrity Professional,
National Health Plan
They have done an outstanding job serving as our primary point of contact and consistently delivering beyond expectations. They champion our requests and help hold the right stakeholders accountable — including themselves. Sagility is a partner we can rely on for timely execution and transparency. The team is highly capable and consistently meets our requirements.
Director, Partner Operations,
Leading Provider Organization
Sagility consistently meets quality targets and maintains excellent service standards. The team is extremely flexible and ready to assist whenever needed.
Supervisor,
Regional Health Plan
Case Studies
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Insights & Resources
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