Cohere Complete™
Outsourced Utilization Management

Transform your specialty UM programs to focus on outcomes — not just transactions

Cohere Complete™ outsourced UM solutions add clinical and operational staff to our Cohere PaaS™ Intelligent Prior Authorization solutions in order to provide health plans with complete, end-to-end and fully delegated utilization management operations for select specialties.

Our model combines deep clinical expertise, AI, and real-time analytics to align health plans, providers, and patients on episode-driven care paths, enabling better care quality and outcomes, with fewer denials, and less unnecessary utilization.

We offer fully-delegated management services for key clinical specialties, including:

Pain management

Physical therapy

Diagnostic imaging


Transaction-focused outsource solutions fail to improve the care journey.

Traditional utilization management programs are about saying “yes” or “no” to individual services, instead of promoting the best patient care and experience. This orientation can delay care, frustrate providers and patients, and misses an opportunity to proactively drive the best care for that specific patient’s entire care journey.

Cohere Complete™ cuts through the maze.

Cohere’s digital-first approach uses interoperability and intelligence to understand the longitudinal patient journey and recommend patient cohort-specific data, evidence-based care paths, oriented to the entire care journey. This allows us to help health plans transform utilization management from a reactive, transaction-based program to a proactive one that anticipates optimal care needs for the patient, and guides providers and patients to care choices that improve outcomes and reduce cost.

Our differentiated approach

Deep clinical expertise combined with innovative technology help bridge the gap from transaction-focused UM to complete care journey management.

Patient cohort-specific care paths

Identify diagnostic cohorts and enable the authorization of the entire care episode, rather
than a series of individual transactions.

Proactive moments of upstream influence

“Nudge” providers toward patient-specific, clinically optimal care choices and high-value specialists at the point of diagnosis.

Intelligent patient and provider-specific decisioning

Incorporate real-time, provider quality, cost, and care appropriateness insights, as well as patient clinical profile information into the automated determination process.


Continuously optimize program performance through advanced clinical analytics including provider benchmarking and performance insights.

Realize the value of a cutting-edge, digital-first approach

Our capabilities have driven these unique, actual results



in complications & unnecessary procedures

Driven by AI/ML-based clinical suggestions


In provider satisfaction



access to patient care

Our capabilities have driven these unique, actual results

Learn how our approach helped drive significant quality improvements in musculoskeletal results for a leading national health plan.

View infographic

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