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Better Data. Better Care. Better Results.

Data alone doesn’t improve outcomes. A unified clinical strategy, proactive care management model, and connected, compassionate member experience do. We bring it all together for you.

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How We Help

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Utilization Management

  • Utilization Review

  • Tailored Pre-Certification Programs

  • Auto-Certification Capabilities

  • Evidence-Based Clinical Guidelines

  • Multi-Specialty Medical Panel

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Care Management

  • Complex Case Management

  • Transitional Care Support

  • High-Dollar Claimants

  • Behavioral Health Support

  • Risk Stratification

  • Population Health

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Specialty Care Programs

  • Maternity Management

  • Member Advocacy & Navigation

  • Specialty Rx

  • OnSIGHT Health

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Earlier Identification, Smarter Intervention

Our model is built around real-time access to data and documentation throughout the member healthcare journey, enabling earlier intervention while treatment decisions are still flexible. The result is clear: optimized treatment plans, reduced cost of care, and a better member experience.

By the Numbers

90

Net Promoter Score

$63M

Annual Savings

4:1

ROI

Our Approach

Self-funded employers carry the responsibility and the risk of their health plan, which is why our approach protects plan dollars while prioritizing the health and well-being of the plan members we service.

At Communitas, we combine nurse‑led advocacy with a deep understanding of how benefit decisions impact cost, utilization, and employee trust.

Our team focuses on:

01

Early engagement

02

Clear guidance

03

Informed decision-making

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Proactive Support,
Powered by Integration

Proactive support only works when it happens early enough to matter. Our integration with WebTPA enables our nurses to act on real-time utilization insights and intervene at multiple points across the member care journey. This means we’re spotting emerging issues early and delivering whole-picture support that feels seamless and creates change.

Learn about WebTPA

Members We’ve Helped, Lives We’ve Improved

01

Situation

A member enrolled in maternity management experienced an unexpected neonatal emergency requiring ECMO and a prolonged NICU stay.

02

Intervention

During outreach, the Maternity Management RN identified gaps in hospital communication, provided extensive education, and coordinated a care plan meeting—empowering the member to advocate for her infant.

03

Outcome

A planned G‑tube surgery was avoided after successful oral feeding trials, allowing the baby to discharge home without tube feedings.

04

Impact

~$50,000 in avoided costs, driven by nurse-led advocacy and proactive support.

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Bringing Clarity
to Chaos

At Communitas, our approach starts with one belief: healthcare is complex, but getting support shouldn’t be.

Our team is made up of real people who genuinely care about helping members understand their benefits, find answers, and move forward with confidence and support in their healthcare journey.

Our Philosophy

Excellence Starts with Our Team

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NCQA

Accreditation

3-Year Case Management

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NCQA

Accreditation

3-Year Utilization Management

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92%

All Favorability

Employee Engagement

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USA TODAY

Top Workplace

4 Years Running

Our Impact

I wanted to provide feedback on the RN Case Management Service I received. It was nice to get a phone call from insurance that was not related to a bill. I would not have been able to manage my son’s care without her assistance because it was simply too overwhelming.

Member

Over the past week, my nurse has gone above and beyond, exemplifying the highest standards of professionalism and compassion. Her commitment to patient care and attention to detail has made a significant positive impact on my experience. Thank you for fostering an environment where professionals like her can thrive and provide such outstanding care.

Member

Every hurdle we faced, I reached out to our Care Coordinator, and she helped me through it. She has been a true angel in my corner while I have faced an uncertain path of navigating this new world of being a parent to a kid with autism who needs help.

Member

I love the Chronic Condition Program where I have a nurse who knows me, discusses my conditions, helps me come up with the right questions for doctors, and sometimes even just listens to me cry.

Member

Empower Your Benefit Plan with an Integrated Clinical Strategy

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