Clinical
Edge
Clinical Edge (formerly GuidingCare) is the nation’s most widely adopted care management platform, improving care quality outcomes and managing costs through an integrated platform that streamlines workflows.
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What Sets Clinical Edge Apart for Health Plans
Clinical Edge helps health plans streamline care, apply AI with confidence, and deliver measurable outcomes at scale.
Integrated Care Management
Consolidate member data, connect care teams, and streamline workflows to deliver whole-person care across all lines of business.
- Unify care workflows with 100+ pre-built APIs
- Deliver whole-person care with evidence-based tools
- Connect members to community resources via referral workflows
AI for Care Teams
Embed HealthEdge AI directly into care management workflows to support clinical decisions and reduce administrative burden.
- Automate clinical documentation
- Augment nurse decisions with AI guidance
- Deploy AI responsibly within every workflow
Measurable Outcomes at Scale
Clinical Edge is the nation's most widely adopted care management platform, trusted by health plans managing millions of members.
- 28M+ lives contracted on the platform
- 100K+ users and 10B+ transactions per year
- Trusted by 20% of Medicaid members nationally
Care and Utilization Management
Clinical Edge Care Management centralizes member data and streamlines workflows, while Utilization Management applies intelligent automation across the authorization lifecycle.
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Whole-person care coordination
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Automated authorization lifecycle
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Evidence-based, compliant workflows
Appeals & Grievances, Population Health, and Member Engagement
Resolve appeals with one-click packet creation, identify at-risk members with real-time analytics, and connect through omnichannel outreach—all in one connected Clinical Edge platform.
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One-click appeals packets
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Real-time risk stratification
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Omnichannel member engagement
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Community referrals
Quality, Insights, and Authorizations
Quality 360, a module of Clinical Edge, links HEDIS gap identification to care workflows, while Business Intelligence and the Authorization Portal speed decisions and provider communications.
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NCQA-certified HEDIS gap closure
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CMS and NCQA dashboards
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Streamlined and automated authorization decisions
Clinical Edge Suite
Care
Management
Streamlined workflows and centralized member data help care teams deliver personalized, evidence-based, whole-person care.
Utilization
Management
Clinically sound, workflow-driven tools with intelligent automation optimize the authorization lifecycle and support compliance.
Appeals
and Grievances
An intuitive, end-to-end solution consolidates appeals, supports regulatory compliance, and delivers one-click packet creation.
Authorization
Portal
End-to-end workflows, automated approvals, and real-time provider communications boost operational agility across your plan.
Mobile
Clinician
Secure mobile access lets field staff run assessments, build care plans, capture consent, and start referrals online or offline.
Member
Engagement
A scalable digital platform pairs omnichannel communication with advanced tools to deliver measurable health outcomes.
Population
Health
Real-time analytics and effective stratification identify at-risk populations and help your teams close care gaps faster.
Quality 360
NCQA-certified quality management links HEDIS gap identification to care workflows, streamlining closure and reducing manual work.
Business Intelligence
Advanced reporting and dashboards for CMS and NCQA give your teams the insight to drive smarter, data-backed decisions.
Clinical Edge
University
24/7 access to module-based training, so staff can build product expertise on their own schedule, from anywhere.
The Most Widely Adopted Care Management Platform
Clinical Edge supports 110M+ members across health plans — the nation’s most widely adopted care management platform, connecting teams around whole-person care.