MHK CareProminence is a cloud-based clinical and utilization management platform designed for health plans, pharmacy benefit managers (PBMs), and provider organizations. It uniquely integrates both pharmacy and medical management into a single system, eliminating data silos and enabling a comprehensive view of each member’s healthcare journey. The platform automates workflows for care management, prior authorizations, and compliance, helping organizations close care gaps, improve quality scores, and reduce administrative costs. MHK CareProminence supports value-based healthcare by aligning organizational processes, enhancing cross-functional collaboration, and ensuring adherence to evolving regulatory requirements. The system is highly configurable, allowing for customizable business rules, structured workflows, and real-time integration with evidence-based clinical guidelines. Its robust compliance features and automation capabilities help minimize risk, maximize operational efficiency, and improve both provider and member engagement.

Key Features

Integrated Pharmacy and Medical Management Combines all pharmacy and medical care management functions in one platform.

• Eliminates data silos for a unified member view
• Supports both medical and pharmacy workflows

Automated Workflow and Task Management Streamlines administrative processes and reduces manual effort.

• Customizable business rules
• Automated prior authorizations and care management tasks

Compliance and Regulatory Support Ensures ongoing adherence to complex healthcare regulations.

• Proactive compliance monitoring
• Regular updates for regulatory changes

Quality and Performance Improvement Drives better health outcomes and higher quality ratings.

• Tools to close care gaps and improve Star ratings
• Performance analytics and reporting

Real-Time Clinical Integration Direct integration with evidence-based clinical guidelines.

• Supports timely, evidence-based prior authorizations
• Reduces time for medical necessity determinations

Member and Provider Engagement Enhances communication and collaboration across care teams.

• Comprehensive member profiles
• Provider portals for streamlined interactions

Benefits

Operational Efficiency Reduces administrative burden and costs through automation.

• Fewer manual processes
• Streamlined workflows

Improved Compliance Minimizes risk of non-compliance with proactive monitoring.

• Adapts to regulatory changes
• Ensures audit readiness

Enhanced Care Quality Supports value-based care and better health outcomes.

• Closes care gaps
• Improves quality scores and member satisfaction

Organizational Alignment Facilitates cross-functional collaboration and data sharing.

• Single source of truth for member data
• Supports enterprise-wide transformation