HealthRules CareManager

Comprehensive Care Management

HealthRules CareManager enables ACO’s, health plans, MCO’s, PCMH’s, Medicare plans, Medicaid plans, TPA’s and pharmacy-related and specialty needs organizations to engage members and patients and manage care in the most efficient ways possible.

HealthRules CareManager provides customers with an individualized focus on:

  • Prevention: Proactive outreach to ensure that healthy people remain healthy by obtaining regular exams and immunizations and participating in preventative programs
  • Care Coordination: Seamless patient experience with personalized evidence-based care plans, multiple care provider coordination, and supporting follow-up care
  • Patient Engagement: Encouraging members and their caregivers to take an active role in their healthcare
HealthRules CareManager’s best-in-class workflow and care plan functionality creates seamless coordination across utilization, case management, disease management and health and wellness, while simultaneously providing real-time updates to the member record and the user’s work board. This multichannel approach allows effortless coordination of the most complex activities in a timely and efficient manner. The result is a system that provides a positive effect on MLR while fully-automating the administration of programs that save on members’ claim costs, promote healthy behaviors and increase member quality of life.


HealthRules CareManager’s best-in-class capabilities include:

  • Member Analyzer: A proprietary, multi-dimensional identification, segmentation and analytics facility offering a powerful combination of query and workflow capabilities
  • Care Pathways: An optional library of pre-configured evidence-based care pathways, which include user-friendly tools designed to meet regulatory requirements and streamline the entire care coordination process
  • Advanced Reporting and Analytics: Robust analytics and reporting, which includes a real-time data warehouse with an easy-to-understand data structure that is optimized for business-oriented analysis and reporting
  • Configuration and Authoring Tools: The ultimate care management toolbox filled with everything you need to dynamically configure and automate any and all aspects of your care management business
  • CareManager Connector: Flexible options for integrating HealthRules CareManager with web services, canonical XML format and HL7v2, HL7v3 and CCD and CDA documents, and collecting, assimilating and delivering data from multiple data sources to our care management programs
  • Provider Portal: A secure platform for providers to request and track authorizations, referrals, view care management registries, collaborate and communicate with the integrated care team
  • Medical Reviewer: A mobile application that delivers all the clinical review details for request for services, eliminates duplicate entry and supports external physician collaboration
  • Assessments Anywhere: A device-aware Web-based application to facilitate the comprehensive assessment of individuals in the community