JSON twin: https://www.healthaidb.com/software/healthedge-care-management-workflow.json
HealthEdge
https://healthedge.com/solutions/care-management-workflow/
HealthEdge GuidingCare Care Management is a cloud-based care management and workflow platform that enables health plans and provider organizations to coordinate whole-person care, automate care planning, and manage utilization through integrated data and mobile clinician tools.
GuidingCare is a configurable care management workflow suite for health plans and providers offering multidisciplinary care coordination, automated care planning, SDOH/community referral integration, mobile clinician app with offline capabilities, population health analytics, utilization management, appeals/grievances, rules designer, and prebuilt Smart-on-FHIR integrations. The platform emphasizes real-time data exchange with payer systems (Care‑Payer), HITRUST security, NCQA-oriented reporting, and extensibility with partner integrations such as Wellframe.
yes
2005
Supports public and private cloud hosting and hosted/on-prem options; customers can choose private cloud/on-prem deployment (US-focused deployments available)
P0705
2025-09-07
commercial proprietary
Contact vendor for licensing, implementation and subscription pricing; demos available.
enterprise_quote
Web browser clients; supports deployment on public cloud, private cloud or hosted/on-prem environments; multi-tenant architecture
product
1.0
{
"company_name": "HealthEdge",
"company_url": "https://healthedge.com",
"company_offices": [
"United States",
"India"
],
"company_founding": "2005",
"product_url": "https://healthedge.com/solutions/care-management-workflow/",
"categories": [
"care management",
"utilization management",
"population health",
"member engagement",
"business intelligence",
"prior authorization",
"appeals and grievances",
"clinical workflow"
],
"market_segment": [
"enterprise",
"payer",
"provider"
],
"links": [
"https://healthedge.com/solutions/care-management-workflow/",
"https://healthedge.com/solutions/care-management-workflow/guidingcare-care-management/",
"https://healthedge.com/solutions/care-management-workflow/guidingcare-authorization-portal/",
"https://healthedge.com/solutions/care-management-workflow/guidingcare-rules-designer/",
"https://healthedge.com/solutions/care-management-workflow/guidingcare-business-intelligence/",
"https://healthedge.com/about-us/",
"https://healthedge.com/resources/press-releases/healthedge-completes-acquisition-of-altruista-health",
"https://www.g2.com/products/guiding-care/reviews",
"https://baincapital.com/news/healthedge-secures-strategic-investment-bain-capital"
],
"summary": "HealthEdge GuidingCare Care Management is a cloud-based care management and workflow platform that enables health plans and provider organizations to coordinate whole-person care, automate care planning, and manage utilization through integrated data and mobile clinician tools.",
"description": "GuidingCare is a configurable care management workflow suite for health plans and providers offering multidisciplinary care coordination, automated care planning, SDOH/community referral integration, mobile clinician app with offline capabilities, population health analytics, utilization management, appeals/grievances, rules designer, and prebuilt Smart-on-FHIR integrations. The platform emphasizes real-time data exchange with payer systems (Care‑Payer), HITRUST security, NCQA-oriented reporting, and extensibility with partner integrations such as Wellframe.",
"target_users": [
"health plan care managers",
"utilization management staff",
"case managers",
"population health teams",
"clinical managers",
"provider organizations",
"payer administrators",
"field/ mobile clinicians"
],
"specialties": [
"care management",
"population health",
"utilization management",
"behavioral health (care coordination)",
"pediatric population health",
"social determinants of health (SDOH) coordination"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Contact vendor for licensing, implementation and subscription pricing; demos available.",
"license": "commercial proprietary",
"deployment_model": [
"cloud_saas (multi-tenant)",
"public_cloud",
"private_cloud",
"hosted/on-prem (private/home and host capabilities)",
"hybrid"
],
"os_platforms": [
"Web (browser)",
"iOS (mobile member engagement)",
"Android (mobile member engagement)"
],
"features": [
"Care management workflows (person-centered, evidence-based)",
"Utilization management",
"Provider authorization / Prior authorization portal",
"Appeals & grievances management",
"Business intelligence & regulatory reporting (CMS/ODAG/CDAG, Part C/D)",
"Population health management (gaps-in-care analytics, SDOH)",
"Member engagement / omnichannel communications",
"Predictive analytics and AI-driven workflow optimization",
"Rules designer (business rules authoring & deployment)",
"Pediatric population health / EPSDT tracking",
"Clinical decision support (GuidingSigns analytics)",
"Workflow/task automation and orchestration",
"Interoperability / data integration layer",
"Training/learning platform (GuidingCare University)"
],
"optional_modules": [
"GuidingCare Rules Designer",
"GuidingCare Business Intelligence (advanced reports)",
"GuidingCare Pediatric Population Health",
"GuidingCare Authorization Portal",
"GuidingCare Appeals & Grievances"
],
"integrations": [
"HealthEdge HealthRules (core admin/claims)",
"HealthEdge Source (prospective payment integrity)",
"Wellframe (digital member engagement)",
"Payer-source integration/connectors",
"EHR systems (unnamed/provider EHR integration)",
"Claims systems",
"Pharmacy data",
"Laboratory data",
"Provider directories / provider portals"
],
"data_standards": [
"FHIR",
"HL7 v2",
"SNOMED CT",
"ICD-10"
],
"api_available": "yes",
"system_requirements": "Web browser clients; supports deployment on public cloud, private cloud or hosted/on-prem environments; multi-tenant architecture",
"compliance": [
"HIPAA",
"NCQA alignment",
"CMS regulatory reporting (Part C/D)",
"HITECH (implicit)",
"HITRUST"
],
"certifications": [
"HITRUST Certification",
"AA Certification for HEDIS Measures Subset"
],
"security_features": [
"encryption (in transit & at rest)",
"role-based access control (RBAC)",
"SSO/SAML support",
"audit logging",
"multi-tenant isolation"
],
"privacy_features": [
"BAA available",
"consent management",
"data anonymization/pseudonymization options"
],
"data_residency": "Supports public and private cloud hosting and hosted/on-prem options; customers can choose private cloud/on-prem deployment (US-focused deployments available)",
"customers": [],
"user_reviews": [],
"ratings": [],
"support_channels": [
"email",
"phone",
"ticketing"
],
"training_options": [
"documentation",
"webinars",
"live_online",
"onsite"
],
"release_year": "",
"integration_partners": [
"Wellframe",
"Anoteros",
"SoftwareOne",
"AppsRunTheWorld"
],
"id": "P0705",
"slug": "healthedge-care-management-workflow",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/healthedge-care-management-workflow.json"
}
}