Who can use the Health Cloud utilization management feature?

The utilization management feature in Salesforce Health Cloud is designed to streamline and enhance the efficiency of healthcare management processes. This feature is particularly useful for both UM clinicians at payer organizations and healthcare providers, as it supports their roles in managing patient care and determining the appropriateness of specific health services.

UM clinicians at payer organizations play a crucial role in reviewing treatment plans and ensuring that patient care aligns with clinical guidelines and health insurance policies. They utilize this feature to assess the medical necessity of services and manage authorizations, ultimately supporting healthcare decisions that benefit both the payer and the patients.

Healthcare providers, on the other hand, use the utilization management feature to improve patient outcomes by better understanding the requirements set forth by payers. They can make data-informed decisions regarding treatment plans and ensure that they comply with necessary guidelines, which is essential for securing authorizations for patient services.

By combining the tools available for utilization management, both UM clinicians and healthcare providers can collaborate effectively, leading to improved patient care and operational efficiency. Hence, the utilization management feature is applicable to both roles, which validates the choice that includes both user categories.