Clinical Expertise 
Empowering smarter healthcare decisions with Clinical-First™ navigation 

Healthcare is complex. Delayed care, fragmented systems and unnecessary costs make it harder for employees to get the care they need. Quantum Health’s Clinical-First model changes that by intervening earlier, coordinating care smarter and driving better holistic health outcomes with an in-house clinical team.

Our unique model integrates care navigation, utilization management, wellbeing support and provider engagement to create a seamless healthcare experience. Starting with clinical expertise and provider collaboration, we ensure early intervention, prevent fragmented care and ultimately enable members to make the best decisions for their care. 

Lady on phone looking at a bill

Our clinically led model drives better outcomes

Unlike other navigation platforms, Quantum Health:  

  • Engages members at the earliest signs of a healthcare event, often before claims are filed, through Real-Time Intercept® 
  • Provides dedicated clinical support, including in-house doctors, nurses, pharmacists and care teams that work together to guide members 
  • Reduces healthcare costs through optimized care paths, utilization management and provider collaboration to cut unnecessary expenses 
  • Improves health outcomes by enabling more preventive screenings, fewer hospital readmissions and increased provider engagement 
a mature woman, a male quantum health employee and a female nurse on the phone

Our Personal Care Guide (PCG) nurses are dedicated advocates

Quantum Health is the only independent navigation solution with an in-house clinical support team – doctors, nurses and care coordinators working together. Our PCG nurses are embedded in each client’s team and become a member’s advocate to help assess, plan and evaluate the best options for their healthcare needs. They blend case management and chronic condition management with dedicated, empathetic support. PCG nurses guide members through care gaps, reducing preventable hospital visits and ensuring adherence to treatment plans.

Female warrior looks at computer at desk in pod

Our approach goes beyond traditional utilization management

We fully own the utilization management (UM) process, advocating for our members in real time through proactive and ongoing consultation with the member’s provider, ensuring faster approvals, fewer denials and optimal site-of-care decisions.  

We prevent denials by working directly with providers, resolving missing documentation before claims are submitted. Our nurses perform reviews, assess progress and help ensure the appropriate level and setting of care. All these factors help eliminate unnecessary inpatient days and address potential barriers to discharge, leading to cost-effective care and clinically better outcomes.  

2%

denial rate vs. the standard 9% carrier denial rate

4.3%

Reduced inpatient stays

$2.08 PM

savings through utilization management and site-of-care review for specialty drugs on the medical benefit

Frequently Asked Questions