Legato Clinical Operations team comprises pharmacists, registered nurses with tertiary hospital bedside experience, HEDIS abstractors, and IT professionals, in addition to individuals with expertise in claims processing, financial recovery, and overpayment.
Together, the team provides services around key enterprise functions:
Utilization Management : The team works closely with internal business partners to ensure superior quality of care and excellent service at affordable costs for the health insurer's members and providers.
Program Integrity : By identifying fraud, waste, and abuse through advanced analytics and strong enterprise governance, the team ensures proper payments to legitimate providers for services provided to eligible members.
Applied IT : With deep expertise in software and web development, server technologies, system interface, UI wire frames, data mapping, etc., the team ensures affordability as well as value-based and quality care for our health insurers' customers’ member organizations. They also ensure a best-in-class provider experience and proactive clinical measures to improve patient care and engagement.