HELIOS, VirtualHealth, Harness The Power

Utilization Management,

Redefined.

HELIOS® UM Delivers:

  • Lower costs with a 360° member view that highlights utilization across the care continuum
  • Maximum efficiency with automated workflows and best-in-class clinical content throughout the review process

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Utilization Management Worthy of HELIOS®
PUTTING MEMBERS FIRST ACROSS THE ENTIRE CARE ECOSYSTEM

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HELIOS® care management has revolutionized healthcare, putting over 7 million members at the center of their respective care ecosystems, improving their outcomes, and helping healthcare organizations reign in costs. VirtualHealth has introduced utilization management capabilities that reflect the game-changing advancements we pioneered in Care Management.

Loaded with leading-edge features, the HELIOS® utilization management suite brings unparalleled efficiency and the intuitive design beloved by our clients. The fully integrated system provides a 360° member and staff view, bringing together our award-winning care management platform and the entire utilization review process. See it in action by scheduling a demo with the form above!

Control the Full Utilization Management Lifecycle
SPEND MORE TIME WITH PATIENTS AND LESS TIME BOUNCING BETWEEN SYSTEMS

The new HELIOS® utilization management capabilities reimagine the end-to-end processes and user journeys to deliver intuitive workflows across intake, routing, assessment, disposition, approval, correspondence, and configurable rules and templates. HELIOS® can be used on a standalone basis to provide the complete workflow for both episodic and chronic service authorization requests or integrate with a third-party system. It supports timely prospective, concurrent, and retrospective reviews to ensure that members get the appropriate care they need, when they need it. 

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Utilization Review Made Easy
LEVERAGING INDUSTRY-LEADING CLINICAL CARE GUIDELINES

Clinical decision support helps organizations perform reviews quickly, efficiently, and supports automated workflows. HELIOS® provides certified real-time integrations with industry-leading content providers such as MCG and Change Healthcare. It also enables clients to incorporate their proprietary medical policies. 

Seamless Integrations
CAPTURE, ANALYZE, AND NORMALIZE DATA

HELIOS® Utilization Management can ingest data from any source to trigger relevant workflows. It can integrate with EHRs, track member information across third-party vendors, and work with any other client systems for a full-spectrum view of the member.

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Integrate your data into automated workflows to reduce manual work and improve audit outcomes.

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Capture all admission, discharge, and transfer (ADT) data and apply the system rules engine to manage workflows.

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Proactively identify & manage members across the whole care continuum, including during care setting transitions.

State-of-the-Art Rules Engine
DRIVE INTUITIVE WORKFLOWS

The embedded rules engine is supported by an extensive library of configurable clinical rules that enables auto-approvals, distinguishes between authorization types, and supports rule hierarchies. 

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HELIOS® PROVIDES:

Provider Directories Auto-authorizations and a decrease in administrative tasks, eliminating redundant work & allowing staff to better manage caseloads
Enrollment + Attribution Care management program identification & referral from utilization management data
Risk Scoring Turnaround times and member/provider notifications that meet NCQA standards