Case Study: Optum360 achieves streamlined clinical licensing and nightly verification of 80,000 nursing licenses with Pegasystems

Optum streamlines clinical licensing and certification

Optum, a large health services and insurance organization, was hampered by fragmented, manual processes for tracking clinician licensure and certification. With clinicians sometimes requiring up to 30 licenses and wide variation across groups, Optum faced audit risk, inconsistent documentation, and a time-consuming burden on staff.

Using Pega’s low-code platform and an agile/DevOps approach, Optum built an enterprise-wide licensure tracking system and delivered a minimum viable product in 10 weeks. By connecting data across the organization and implementing case management and a clinician-level chargeback model, the solution reduced administrative noise, improved payment tracking and allocation, and now verifies over 80,000 nursing licenses nightly—largely using out-of-the-box Pega functionality.

Optum360

Preston Meadows

Business Implementation Manager