Financial Risk Management & Health Plan Operations
Take on Full-Risk or
Launch a Health Plan?
Conifer Payer Operations for Providers
Conifer Payer Operations for Providers helps you with the necessary technology infrastructure and management oversight to support licensed health plan operations. If you already have a health plan solution, our platform can help you improve performance so you can focus on delivering quality care and pursuing strategic opportunities. Our centers of excellence perform claims operations, eligibility and enrollment, care management (including prior authorization and concurrent review), network management, and customer and provider relations services to meet the needs of your participants and providers.
We have URAC accreditation for health utilization management, case management, and transitions of care services.*
We are URAC vendor-certified for case management, disease management, and health utilization management.*
*URAC accreditation through Conifer Care Continuum Solutions, a Conifer Health Solutions company
- Launch a health plan or receive delegated risk from a payer
- Achieve efficiencies by leveraging Conifer Health’s expertise and experience with larger health plan operations
- Tailor your health plan solution to meet relevant claims processing requirements
- Focus on the delivery of quality care to members, while managing the financial risk associated with the cost of care
Network Management Including Incentive Design
Health plan success starts with the network. Conifer Health can build and manage your health plan’s network to help ensure alignment of clinical and financial goals.
Understanding and coordinating the care of the population is core to driving value in the health system. Our medical management team leverages the strengths of our ConiferCore® Population Health Intelligence platform.
Conifer Health has the infrastructure to help you provide excellent and attentive service to improve member satisfaction and address member issues as they arise.
Use Conifer Health to deliver superior administrative services that afford competitive advantage to your health plan without having to build the internal staffing and management to perform daily health plan functions.
Financial Reporting and Performance
Manage your health plan’s performance and support compliance with accounting and reporting requirements. Conifer Health can provide proactive reports which help you identify performance opportunities, benefitting from years of health plan experience and benchmarks.
“We knew the sooner we had a platform in place to help guide us in managing the population, the sooner we could achieve the goals of our value-based contracts”
Vice President of Administration,
KentuckyOne Health Partners