Faster Decisions. Cleaner Audits. Compliant by Design.
Utilization Management Services
Blue Eagle Consulting provides senior UM consultants, prior authorization nurse reviewers, and clinical SMEs who help payers meet CMS turnaround times, reduce backlog, and protect publicly reported PA metrics.
UM Is No Longer Just a Cost Center. It is a Compliance Risk.
Since January 1, 2026, CMS-0057-F has required impacted payers to issue standard prior authorization decisions within 7 calendar days and expedited decisions within 72 hours. Public reporting of PA metrics began March 31, 2026, putting payer performance in plain view of providers, regulators, and members. The proposed CMS-0062-P rule will tighten drug PA windows to 72 hours standard and 24 hours urgent.
Internal UM teams were already under pressure. Now, the margin for error is gone. The plans that get this right rebuild their UM operating model with the right mix of clinical talent, platform expertise, and process redesign. That is the work we do.
7
Calendar Days Standard
72
Hours Expedited
Where Our UM Consultants Step In
Prior Authorization Review
Licensed nurse reviewers who clear backlogs and meet TAT requirements.
System Configuration
Platform builds, rules updates, and workflow optimization.
QA Audits and IRR
Inter-rater reliability programs that defend audit findings and CMS Star Ratings.
Grievance and Appeals
Documentation, casework, and process redesign for faster, defensible decisions.
Auth.Chex and Resolution
Specialized resolution work for complex authorization exceptions.
HCC and ICD-10 Mapping
Clinical coding expertise tied to risk adjustment accuracy.
Case and Disease Management
Embedded clinicians who support care coordination across high-cost populations.
Clinical Chart Review
Targeted chart review for medical necessity, appeals defense, and audit support.
Utilization Review
Inpatient, outpatient, and concurrent review support across commercial, Medicaid, and Medicare Advantage lines.
Supplemental Staffing
Surge capacity for backlogs, seasonal spikes, and project ramps.
Platform-Fluent From Day One
Our UM consultants are not generalists. They come with hands-on experience in the systems your team uses every day, which means less ramp-up, fewer training hours, and faster value.
Our UM consultants are not generalists. They come with hands-on experience in the systems your team uses every day,
which means less ramp-up, fewer training hours, and faster value.
Trusted by Payers Who Cannot Afford to Get UM Wrong
20+
Years in Business
627
Completed Projects
18
Supported Platforms
A Process Built Around Your Operating Model
Scope
We start with your TAT performance, backlog data, and platform constraints to define the right consultant profile.
Match
We hand-pick consultants whose certifications, system fluency, and clinical background fit your specific gap. No volume submission.
Embed
Consultants integrate into your team within days, working in your workflows and your tools.
Transfer
When the engagement ends, your internal team is stronger, with documented playbooks and trained super users.
UM Insights From Our Team
Applying a US Based Contract Nursing Service for Prior Authorization Reviews
PAs are necessary for Health Plan cost containment and should be handled fast and efficiently. Yet, Health Plans have...
Faster Authorizations, Fewer Delays: How Payors Can Strengthen UM
As payors move through 2026, the need to strengthen UM is more urgent than ever. Faster authorizations, fewer delays, and consistent turnaround times are…
Supporting Staff Under Pressure: How Clinical Consultants Ease the Load
Clinical consultants play a key role in supporting healthcare teams when pressure rises. If you have ever watched staff race through a packed shift, you know…
Hidden Cost of Prior Authorization Delays
A patient is ready to begin treatment. The provider has done the evaluation. The care plan is approved internally. Then everything stops while the team waits for…