myNEXUS

What myNEXUS does

myNEXUS is a healthcare management platform that enables physicians to remotely monitor and coordinate the care of patients, with particular emphasis on post-acute and home-based recovery following hospitalization. Founded in 2014 and headquartered in Brentwood, Tennessee, myNEXUS operates today as a brand within Carelon's Medical Benefits Management (MBM) division — a clinical platform anchored by 370+ board-certified physicians and 1,000+ clinicians spanning 50+ specialties with 35+ years of medical benefits management experience. Within Carelon MBM's broader solution portfolio, myNEXUS-aligned capabilities include the Home-Based Post-Acute Solution and the broader Post-Acute Complete offering, which coordinate home health, durable medical equipment, facility-based rehabilitation, and member-facing tools such as MyChart-enabled palliative care access.

The underlying product architecture is workflow- and evidence-based rather than technology-led: clinical decisions are governed by proprietary evidence-based criteria applied across diagnostic, specialty, musculoskeletal, oncology, and post-acute care domains. The platform reaches all 50 U.S. states and reports provider satisfaction above 90%, indicating scaled distribution but limited disclosure of proprietary technology, APIs, or developer-facing integrations. No revenue model, pricing, or contract structure is disclosed in the available data; however, given the buyer base (health plans, integrated payers, and at-risk provider organizations) and the integration into Carelon — which itself sits within Elevance Health's broader health-services ecosystem — the operating model is consistent with enterprise B2B2C contracts under which myNEXUS services are paid for by payers or delegated risk-bearing entities to manage defined post-acute and home-based care populations on a per-member, per-episode, or shared-savings basis.

myNEXUS has raised approximately $31.7M in disclosed funding across 2014, 2017, and 2020, anchored by WindRose Health Investors and MTS Health Partners. Leadership includes co-founders John Dant and McArthur VanOsdale, alongside a clinical and operating bench (Chief Clinical and Compliance Officer, SVP Operations, Chief People Officer). The strategic positioning today is best understood as a clinically-credentialed, nationally distributed care-coordination franchise within Carelon MBM — scaling primarily through cross-sell into adjacent Carelon capabilities (Care Navigation, Behavioral Health, Pharmacy, Payment Integrity) rather than as a standalone technology disruptor.

Name

myNEXUS

Legal name

Carelon

Website

https://mynexuscare.com

Company type

Private

Founded year

1989

Operating status

Operating

Headcount range

251–500 employees

Short description

myNEXUS is a physician-facing healthcare management platform for remote patient monitoring and home-based post-acute care coordination, now operating as a brand within Carelon's Medical Benefits Management division and serving U.S. health plans across all 50 states.

Ownership category

akta.pro rank

Product category

Healthcare Care Management

NAICS

Ambulatory Health Care Services (621)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Remote Therapeutic Monitoring (RTM) & Digital Rehabilitation Platforms (HLALABAK)

akta.pro secondary industry

DTx/SaMD Deployment, Integration & Reimbursement Enablement (HLACANAO)

Keywords

• Remote patient monitoring
• Care management platform
• Clinical decision support
• Medical benefits management
• Post-acute care coordination

Headquarters

HQ city

Brentwood

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Core offering

myNEXUS is a healthcare management system that enables doctors to remotely monitor their patients' health. The platform supports care coordination across the continuum, leveraging a mobile application for patient engagement and clinical workflows for providers. Operates within the broader Carelon Medical Benefits Management portfolio, which delivers clinical decision support across diagnostic, specialty, oncology, and post-acute care domains.

Product overview

Carelon Medical Benefits Management (MBM) is a comprehensive platform offering an integrated portfolio of clinical solutions designed to address inappropriate care and deliver connected healthcare experiences. The platform is built on a foundation of over 370 board-certified physicians and 1,000+ clinicians spanning 50+ specialties with 35+ years of experience. The solution architecture comprises four primary care management domains: Diagnostic & Specialty Care (Radiology, Cardiovascular, Sleep, Surgical Procedures), Musculoskeletal & Rehabilitation (Musculoskeletal, Rehabilitation), Oncology (Medical Oncology, Radiation Oncology, Genetic Testing), and Post-Acute Care (Post-Acute Complete, Home-Based Post-Acute, Facility-Based Post-Acute, Durable Medical Equipment). Additional capabilities include Behavioral Health, Care Navigation, Operations & Digital Transformation, Payment Integrity, and Pharmacy services. The platform covers all 50 states and maintains 90%+ provider satisfaction.

Differentiator

Problem solved

Functional benefit

Products and services

• myNEXUS Remote Patient Monitoring Platform Healthcare management system that enables physicians to remotely monitor their patients' health through a digital platform with mobile app functionality. Designed for doctors and care providers managing patient populations outside of in-person visits.
• Carelon Medical Benefits Management Comprehensive clinical solutions platform addressing inappropriate care and delivering connected healthcare experiences. Spans diagnostic and specialty care, musculoskeletal and rehabilitation, oncology, and post-acute care domains. Built on 370+ board-certified physicians and 1,000+ clinicians across 50+ specialties, serving all 50 U.S. states with 90%+ provider satisfaction.
• Care Navigation Service that connects members with wraparound resources including health coaching, in-home assessments, and social drivers of health support to address non-clinical factors impacting health outcomes.
• Behavioral Health Services Comprehensive behavioral health services including mental health and substance use disorder management delivered across all 50 states through the Carelon platform.
• Palliative Care Specialized palliative care services including MyChart-enabled member access for care management, supporting patients with serious illness.
• Pharmacy Services Pharmacy services including prescription management and pharmacy benefit management delivered through the carelonrx.com platform.
• Post-Acute Complete Comprehensive post-acute care management solution designed to improve post-hospitalization recovery times and members' quality of life, including home-based and facility-based post-acute care options.
• Payment Integrity Services to ensure accurate claims payment and reduce fraud, waste, and abuse in healthcare billing.
• Healthcare Research Services Healthcare research capabilities to drive evidence-based clinical decision-making and sustainability in healthcare delivery.

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Recent moves5 records

Expansion highlights4 records

Direct peers

• eviCore healthcare: A leading medical benefits management platform offering utilization management for radiology, cardiology, oncology, and post-acute care across health plans and providers — a direct competitor (and now also within the Carelon family) to myNEXUS-aligned solutions.
• AIM Specialty Health: Provides specialty utilization management for radiology, oncology, sleep, and post-acute care to health plans, directly overlapping with the Carelon MBM/myNEXUS solution modules.
• National Imaging Associates (NIA): Subsidiary of Evolent Health offering imaging and specialty utilization management; competes head-to-head with Carelon MBM's Radiology and specialty care modules on health-plan RFPs.
• MCG (formerly Milliman Care Guidelines): Provides evidence-based clinical decision-support and care guidelines used in utilization management, comparable to the evidence-based criteria myNEXUS/Carelon MBM applies across its Radiology, Cardiovascular, and post-acute solutions.
• HealthHelp: Specialty benefits management company focused on radiology, cardiology, oncology, and sleep utilization — directly comparable to Carelon MBM's Diagnostic & Specialty Care portfolio that myNEXUS sits within.

Broad incumbents

• Optum Health (UnitedHealth Group): Diversified health services arm of UnitedHealth Group offering MBM, care navigation, behavioral health, and pharmacy at enormous scale; competes broadly with Carelon/myNEXUS across the same health-plan contract opportunities.

Emerging players

• Cohere Health: AI-driven prior authorization and utilization management platform for specialty care including post-acute and musculoskeletal; competes with Carelon MBM/myNEXUS for health-plan contracts with a more technology-forward delivery model.
• Medical Review Institute of America (MRIoA): Independent review organization providing peer-review and utilization management services across multiple specialties; an emerging alternative to Carelon MBM's in-house clinical review process for plans seeking external review vendors.
• Hippocratic AI: Emerging AI-agent platform for post-acute and chronic care patient engagement and monitoring — partial overlap with myNEXUS's remote monitoring and care-navigation thesis, though at a much earlier stage.

Others

• AlayaCare: Cloud-based home health and post-acute care platform serving agencies with remote patient monitoring and care coordination software; adjacent ecosystem participant whose end customers overlap with Carelon MBM/myNEXUS post-acute workflows.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights5 records

Customer concentration

• LinkedInlinkedin.com/company/mynexus-llc
• Xx.com/mynexuscare

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 records

Funding overview

Funding rounds4 records

Investors3 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about myNEXUS