Delegated Clinical Services for Health Plans

Delegated Clinical Services for Health Plans, Powered by Jiva In Partnership with Clearlink

Health plans face persistent operational demands across care management, utilization oversight, and regulatory compliance. These demands are often intensified by staffing constraints, expanding product portfolios, and increasing scrutiny from state and federal regulators. Through its partnership with Clearlink, ZeOmega supports health plans with clinically grounded operational services delivered on the Jiva platform.

Together, ZeOmega and Clearlink deliver delegated clinical services that combine clinical and operational expertise with ZeOmega’s configurable, workflow-driven technology. The result is a structured, technology-enabled approach to care and utilization management that allows health plans to streamline operations, predict performance, and provide better experiences for members, providers, and plan staff.  

A Thoughtful Approach to Clinical Operations

ZeOmega’s Jiva platform provides the digital foundation for care management support, while Clearlink brings deep operational and clinical expertise across managed care populations.

Together, ZeOmega and Clearlink help health plans:

• Extend care and utilization management capacity without fragmenting systems or data
• Maintain alignment with CMS, NCQA, URAC, and state-specific requirements
• Establish consistent workflows across lines of business and member populations
• Monitor performance through structured reporting and operational transparency

Care Management Services

Effective care management depends on consistency, clinical judgment, and sustained member engagement. Through delegated care management services delivered on Jiva, Clearlink helps health plans strengthen programs across Medicaid, Medicare Advantage, SNPs, and commercial programs with integrated processes that support holistic, person-centered care.

Care management services include:

• Comprehensive care plans that incorporate medical, behavioral, and social needs to support whole-person care
• Documented outreach and engagement activities supported by defined workflows to support member engagement and participation
• Reporting that supports oversight of outcomes, gaps in care, and program effectiveness
• Plan-of-care templates to streamline documentation and reinforce best practices

Jiva provides the care management system through which activities are documented, monitored, and evaluated, allowing health plans to maintain continuity across internally managed and externally supported programs.

Utilization and Medical Management Services

Utilization management requires disciplined processes, clinical consistency, and reliable documentation. Through Clearlink, health plans can access utilization and medical management services delivered within Jiva, supporting reduced costs, improved care transitions, and a more effective UM program with measurable ROI.

Utilization management services include:

• Workflows that support trackable, improved ROI
• Identifying opportunities for cost savings, improved access, and proactive intervention
• Support for utilization, care transitions, and readmission oversight
• Processes that ensure access to timely and clinically appropriate care while maintaining compliance with regulatory standards

Jiva helps ensure utilization activity remains traceable, auditable, and aligned with plan policies.

Appeals and Grievances Management Services

Appeals and grievances represent a significant area of reputational and regulatory risk. Clearlink provides support for these functions through documented processes within Jiva.

A&G management services are designed to support:

• Delivery of standard, best practice procedures, structured workflows, and work queue management for timely resolution
• Timely intake, identification, and resolution work
• Consistent documentation, monitoring, and quality review processes to support resolution and regulatory reporting
• Root cause analysis and improvement plans to reduce risk
• Oral, written, and language assistance to develop culturally appropriate A&G communication

Provider Portal Assistance

Provider experience directly affects efficiency, adoption, and satisfaction. Together, ZeOmega and Clearlink help plans reduce administrative burden and support seamless communication between providers and care teams.

Services enabled through Jiva include:

• Direct provider access through your existing portal to improve coordination and reduce administrative delays
• Visibility into relevant information and care plans, helping providers make timely, informed decisions at the point of care
• Streamlined authorization processes by enabling providers to submit requests and receive auto-approvals when criteria are met

These capabilities contribute to more efficient collaboration between providers, care teams, and the health plans that support them.

Designed for Oversight, Stability, and Growth

ZeOmega and Clearlink’s partnership is intended to help health plans that value operational efficiency and long-term program stability. Jiva provides a platform that supports oversight across care management, utilization management, appeals and grievances, and related clinical operations with greater speed, compliance, and transparency.

Learn More About Clinical Services Delegation Solutions

If your organization is exploring delegated clinical services or looking to strengthen existing programs, we can help. Contact us to discuss how ZeOmega and Clearlink can support your goals for efficiency, compliance, and better outcomes.

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Additional Resources

Testimonial: Clearlink Partners

Press Release: ZeOmega & Clearlink Partners to Streamline Delegated Clinical Services

Webinar: Near Real-Time Prior Authorizations With AI

Solution Trends: The Smart Fax Automator

Solution Trends: Smart Auth Optimizer

Solutions Trends: Medical Guidelines Digitizer (MG Digitizer)