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Clinical CareAdvance®
CareAdvance is a flexible, automated care, disease and utilization management platform that reduces operating costs, helps care managers amplify their impact and enables better member health outcomes. Out-of-the-box care management programs are designed to help clients meet NCQA standards and perform well on HEDIS® and Star ratings.
Our standard clinical content, which incorporates social determinants of health and accounts for behavioral health, is regularly checked by third-party reviewers for alignment with NCQA standards. Automated workflows, triggers and processes reduce turnaround times, elevate efficiency and avoid errors. This greater efficiency reduces clinical and administrative staffing pressure and speeds clinical decision-making.
Our low-code/no-code solution empowers care management teams to configure care programs without waiting for internal IT support. Integrations with core administrative systems, our Value-based Benefit Solution and first-level criteria promote collaboration among members, providers health planscare, utilization and disease management teams.
The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.
Improve care management performance
Improve care management performance

Elevate efficiency and accuracy, relieve staffing pressure and enhance collaboration among members, providers, and health plan care teams.

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Unify case, utilization and disease management
Unify case, utilization and disease management

Our low-code/no-code suite of solutions empowers care, disease and utilization management to configure and incorporate core system data without needing to queue for IT support.

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Deploy high-quality care programs faster
Deploy high-quality care programs faster

Our solution delivers out-of-the-box care management programs built upon accredited clinical content and leveraging our highly trained clinical team.

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Cognizant Named a Leader in Everest Group® Care Management Platforms for Payers PEAK Matrix® Assessment 2025

Cognizant is recognized for strong vision, next-generation platform capabilities and commitment to continuous innovation—including advanced automation, real-time insights and generative AI.

Read the report
Care Management Platforms for Payers 2025

AI-driven innovations in care management

CareAdvance now includes built-in generative AI capabilities that help health plans streamline complex workflows, improve care quality and enhance the day-to-day experience of care managers. These enhancements deliver fast, accurate insights directly within the care management process, enabling teams to make decisions with greater speed and confidence.

Member and assessment summary

Care managers often waste valuable time piecing together a member’s health history, assessments and progress from multiple systems. AI organizes these details into a single, editable view, giving teams an immediate, comprehensive picture of the member’s status.

  • Eliminate repetitive data gathering across fragmented systems
  • Provide a real-time, consolidated member profile for faster decision-making
  • Deliver editable summaries that can be tailored to each member’s care plan
TriZetto Intelligent Document Conversion Services

Faxed and scanned attachments are still common in care management and utilization management but keying them into systems drains resources and creates risk. TriZetto® Intelligent Document Conversion Services use AI to ingest and convert unstructured documents into structured, actionable data that flows directly into CareAdvance.

  • Eliminate manual fax handling and reduce transcription errors
  • Speed up authorization workflows with no-touch ingestion
  • Free staff from repetitive administrative tasks to focus on higher-value work
Drawing conclusions

Interpreting assessments and extracting meaningful outcomes can delay case resolution. AI pinpoints critical findings within assessments and generates editable conclusions that enable care managers to finalize recommendations quickly and confidently.

  • Shorten the time from assessment to actionable recommendations
  • Surface the most clinically relevant insights for decision support
  • Provide editable outputs to maintain flexibility and clinical judgment
Medication summary

Frequent medication changes and fragmented records raise the risk of outdated or inaccurate treatment plans. AI monitors medication lists, flags modifications and consolidates updates for streamlined review.

  • Maintain accurate, current medication records for every member
  • Reduce manual reconciliation effort and associated risks
  • Support safer, more consistent care delivery through automated updates
Clinical document summary

Prior authorizations and utilization reviews often stall because utilization managers must sift through lengthy attachments line by line. Generative AI changes this by distilling documents into decision-ready summaries that reduce friction in the process. By removing delays and administrative burden, health plans can speed access to care, control costs and allow staff to focus on higher-value clinical work.

  • Lower per-case processing costs by cutting review times from minutes to seconds
  • Accelerate prior authorization approvals, reducing treatment delays for members
  • Free care teams to focus on clinical judgment and member engagement, not paperwork
Clinical content comparison tool

Evolving evidence-based guidelines make it difficult to keep care programs aligned and compliant. AI compares existing clinical content with the latest releases and provides clear summaries of what has changed.

  • Ensure care programs remain aligned with accreditation and quality standards
  • Automate compliance reviews to save staff time and effort
  • Speed updates to clinical content across conditions and care pathways

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