Reduced administrative burden for providers

Built on nationally recognized standards, our URAC-certified* solution creates efficient workflow and is easy for providers to use. Optum Utilization Management (UM) can automate determinations for certain procedures, delivering an immediate response to providers.

*Utilization Review Accreditation Commission 

Recognized as leading to better outcomes

CMS has designated Optum UM as Quality Improvement Organization (QIO)-like for meeting rigid clinical standards for appropriate courses of treatment. QIO-like designation is important to states seeking Federal Financial Participation (FFP) for costs associated with medical and utilization reviews.

Understand member and business needs

Optum UM aggregates member and claims data from multiple sources to analyze and quickly evaluate a member’s risk level. State agency staff have access to benefit determination records and reporting for aggregate analysis and case-by-case business need.

Balancing technology and human expertise

Our unique combination of technology and clinical expertise helps members receive the appropriate care as quickly as possible. With decades of experience managing population health, we know how to engage providers and members to achieve better health outcomes.