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Case Study

Optum streamlines clinical licensing and certification

  • Needed an enterprise-wide solution for tracking licensure and certification
  • In 10 weeks, Optum went from documenting needs to having a minimum viable product
  • Digitally transformed processes into robust, clinician-centric solutions

“95% of what we do is built on out-of-the box Pega functionality. We are not coding these things ourselves, we're not utilizing any sort of special programming tools, in some instances we are, but really the lion share is done in out-of-the-box Pega on the platform.”

Preston Meadows Business Implementation Manager, Optum

The Business Issue

Optum was struggling with the licensure and certification for the clinicians on its staff. Since clinician-employees don’t go through the typical credentialing process that providers would in a hospital system, it’s up to Optum to ensure licenses are documented, all mandatory files are on-hand in case of an audit, and everything is accessible. The challenge was that the organization uncovered a high degree of process variation from one group to the next. For employees that may need up to 30 licenses to do their jobs, the lack of consistency made the licensure process unnecessarily complex and time-consuming.

To streamline the process and ease the heavy burden for clinician employees, the health insurer needed to break down silos and bring together the data and processes across the groups.

The Solution

Optum was looking for an enterprise-wide system to obtain, maintain, and track clinical licensure; one that would be quick to implement, user-friendly, flexible, transparent, and enable the sharing of data across disparate clinician systems. To deliver its solution, Optum adopted an agile development process and DevOps to quickly implement a minimum viable product and ensure that additional product features could easily be added on an ongoing basis.

With Pega’s low-code capabilities, Optum was able to move the lead business architect to the business side, drastically improving delivery due to deeper subject matter expertise. By connecting data across the enterprise, Optum also developed a chargeback model to track spending down to a clinician-level.

The Results

  • Reduced noise and helped clinicians focus on their work by developing high-touch customer service across multiple work streams using case management
  • Improved payment tracking and receipt association to allocate accurate charges to the appropriate business segments
  • Can verify more than 80,000 nursing licenses on a nightly basis
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Tags

Industry: Healthcare Product Area: Platform Challenge: Enterprise Modernization
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