NaviHealth
NaviHealth is a UnitedHealth Group/Optum subsidiary that provides AI-driven post-acute care authorization and care transitions management for Medicare Advantage health plans, serving UnitedHealthcare, Humana, and Aetna across a network of 14,500+ skilled nursing facilities.
- Company typePrivate
- Founded2012
- HeadquartersBrentwood, United States
- Headcount1,001–5,000
- GTM typeB2B
- OfferingServices
What NaviHealth does
NaviHealth is a UnitedHealth Group subsidiary, operating within the Optum division, that provides post-acute care management and prior authorization services to Medicare Advantage health plans and post-acute care providers across the United States. Founded in 2012 and headquartered in Brentwood/Nashville, Tennessee, the company coordinates care transitions from acute hospital settings into skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities, and home-based care. Its core product is the nH Predict algorithm, an AI-driven tool that processes prior authorization requests for post-acute services and is central to the company's utilization management workflow; the algorithm has been the subject of regulatory scrutiny and litigation over alleged AI-driven care denials.
NaviHealth operates a network of more than 14,500 skilled nursing facilities across all 50 states and employs over 2,400 licensed care coordinators, including registered nurses, physical and occupational therapists, and speech-language pathologists. Its named enterprise customers include UnitedHealthcare, Humana, and Aetna (CVS Health), and according to OIG reporting the company processes roughly half of all Medicare Advantage post-acute care authorization requests across these three largest MA insurers. Performance metrics cited by Optum include 86% member satisfaction with care coordinator services, 3.7 combined average Star Ratings for health plan partners, and a 14% denial rate that has drawn federal attention due to a 95% appeal overturn rate.
The business model is B2B managed services: NaviHealth contracts with Medicare Advantage health plans as a utilization management vendor and is compensated for processing prior authorization requests and managing post-acute care transitions, with revenue structures tied to utilization management and cost containment outcomes rather than publicly disclosed per-unit pricing. Go-to-market is sales-led and channeled through Optum/UnitedHealth Group enterprise relationships. Strategic acquisitions include Curaspan (2016) and Innovative Healthcare Delivery (2020). As a non-publicly-reported subsidiary of UnitedHealth Group (NYSE: UNH), NaviHealth does not disclose standalone financials.
NaviHealth firmographics
Firmographics- Name
- NaviHealth
- Legal name
- NaviHealth
- Website
- https://navihealth.com
- Company type
- Private
- Founded year
- 2012
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- NaviHealth is a UnitedHealth Group/Optum subsidiary that provides AI-driven post-acute care authorization and care transitions management for Medicare Advantage health plans, serving UnitedHealthcare, Humana, and Aetna across a network of 14,500+ skilled nursing facilities.
- Ownership category
- akta.pro rank
NaviHealth industry classification
Industry- Product category
- Post-Acute Care Management
- NAICS
- Services for the Elderly and Persons with Disabilities (62412)
- SIC
- Services-Health Services (8000)
- akta.pro primary industry
- Post-Acute & Transitional Care Virtual Platforms (SNF/home health coordination) (HLALABAG)
- akta.pro secondary industries
- Post-Acute, Transitional Care & Readmissions Virtual Programs (Payer-Sponsored) (HLALACAG), Care Coordination, Referral Management & Transitions-of-Care Pathways (HLACAGAL), Transitions of Care Management (Hospital/SNF/Home) (HLADALAD)
Keywords
Where NaviHealth is headquartered
LocationHeadquarters
- HQ city
- Brentwood
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
NaviHealth business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales
Revenue model
- Healthcare administrative services: NaviHealth generates revenue by processing prior authorization requests and providing post-acute care management services on behalf of Medicare Advantage insurers. As a UnitedHealth Group subsidiary operating under Optum, it serves as a contractor managing care authorization workflows for health plan clients, with compensation structures tied to utilization management and cost containment outcomes.
Go-to-market motion1 record
Distribution channels2 records
Marketing channels2 records
NaviHealth product offering
Product offeringCore offering
NaviHealth provides post-acute care management and prior authorization services for Medicare Advantage health plans. The company coordinates patient transitions from acute care to skilled nursing, rehabilitation, and home settings through a national network of 14,500+ skilled nursing facilities and 2,400+ licensed care coordinators. Its proprietary nH Predict AI tool processes prior authorization requests to determine coverage outcomes for post-acute services.
Product overview
NaviHealth operates as a subsidiary of UnitedHealth Group/Optum, providing post-acute care management solutions. Its primary offering is the nH Predict tool, an AI-driven algorithm that processes prior authorization requests for post-acute care services including skilled nursing facilities, long-term care hospitals, and inpatient rehabilitation facilities. NaviHealth processes approximately half of all Medicare Advantage authorization requests in the U.S.
Differentiator
Problem solved
Functional benefit
Brands
- nH Predict: AI-driven care denial tool used for prior authorization decisions in post-acute care settings, including skilled nursing facilities and long-term care hospitals.
Products and services
- nH Predict AI-driven predictive algorithm used for processing prior authorization requests for post-acute care, including skilled nursing, long-term care hospital stays, and inpatient rehabilitation. The tool analyzes patient data to determine care authorization outcomes.
- Post-Acute Care Solutions / Care Transitions Service guiding members transitioning from acute care to skilled nursing, rehabilitation, and home settings, with over 14,500 skilled nursing facilities across all 50 states and 2,400+ licensed care coordinators (RNs, physical/occupational therapists, speech-language pathologists). Designed for health plans serving vulnerable older adults.
- Skilled Nursing Facility Program
Quantifiable outcome
- 86% of members report satisfaction with care coordinator services
- +3 more outcomes
Companies that use NaviHealth
Customer profileNamed customers3 records
Segments2 records
Ideal customer profiles2 records
NaviHealth technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability4 records
Feature2 records
NaviHealth partnerships and signals
Strategic signalPartnerships
Three partnerships are on record, tiered flagship and core.
- UnitedHealth GroupflagshipNaviHealth is a wholly-owned subsidiary of UnitedHealth Group, operating within the Optum division. As a subsidiary, it benefits from integration with UnitedHealth's insurance business (UnitedHealthcare) and Optum's data/analytics infrastructure. Legal cases such as Estate of Lokken v. UnitedHealth Group reference naviHealth's AI-driven care denial practices under the parent company's umbrella.
- Medicare Advantage Health Plans (UnitedHealthcare, Humana, Aetna)coreNaviHealth processes prior authorization requests and provides post-acute care management services to Medicare Advantage insurers. The OIG report identified that naviHealth processed approximately half of all authorization requests for UnitedHealth, Humana, and Aetna Medicare Advantage plans, with denial rates of 14% compared to other contractors.
- Post-Acute Care Providers (Skilled Nursing Facilities)coreNaviHealth coordinates care with a network of over 14,500 skilled nursing facilities across all 50 states as part of its post-acute care management services. The company provides clinical collaboration, discharge planning, and care transition support connecting acute care settings with post-acute providers.
Scale indicators3 records
Recent moves6 records
Expansion highlights5 records
NaviHealth competitors and assessment
Company assessmentEmerging players
- HHAeXchange: HHAeXchange offers home health agency management and payer-provider coordination software, addressing a downstream post-acute setting that NaviHealth transitions members into.
- MatrixCare: MatrixCare (a ResMed company) provides EHR and care coordination software for skilled nursing, home health, and hospice, overlapping with NaviHealth's SNF and post-acute referral network.
- AlayaCare: AlayaCare provides home and community care software with scheduling, clinical documentation, and payer integrations, competing in adjacent post-acute and home-based care workflows.
- PointClickCare: PointClickCare is a leading EHR and care coordination platform for skilled nursing facilities, sitting on the provider side of the same post-acute ecosystem NaviHealth manages from the payer side.
Direct peers
- AIM Specialty Health: AIM Specialty Health (an Elevance Health company) delivers utilization management and clinical appropriateness review for health plan members, competing head-to-head with NaviHealth for MA prior authorization contracts.
- CareCentrix: CareCentrix (also part of UnitedHealth Group/Optum) coordinates post-acute and home-based care for health plan members, overlapping with NaviHealth's transitions-of-care and post-acute management offering.
- WellSky: WellSky provides care coordination, referral, and analytics software used by post-acute providers and payers, addressing the same post-acute workflow that NaviHealth orchestrates for MA plans.
- MCG Health: MCG (a Hearst company) publishes care guidelines and decision-support tools that underpin utilization management workflows at health plans, making it a direct functional peer to NaviHealth's nH Predict-driven authorization logic.
- eviCore healthcare: eviCore (a Cigna/Evernorth business) provides prior authorization and utilization management services to health plans, directly overlapping with NaviHealth's core MA post-acute authorization workflow.
Broad incumbents
- Modivcare: Modivcare is a publicly traded non-emergency medical transportation and personal care provider serving managed care plans, intersecting with NaviHealth's post-acute member journey at the home- and community-based layer.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat6 records
Key risks6 records
Key highlights6 records
Customer concentration
NaviHealth social profiles
Digital presenceNaviHealth financial estimates
Financial estimateRevenue estimate
Valuation estimate
NaviHealth leadership team
Management profileNumber of profiles
Profiles11 records
NaviHealth funding detail
Funding detailFunding overview
Funding rounds3 records
Investors9 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
NaviHealth M&A and investment
M&A and investmentM&A2 records
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about NaviHealth
What does NaviHealth do?
NaviHealth provides post-acute care management and prior authorization services for Medicare Advantage health plans. The company coordinates patient transitions from acute care to skilled nursing, rehabilitation, and home settings through a national network of 14,500+ skilled nursing facilities and 2,400+ licensed care coordinators. Its proprietary nH Predict AI tool processes prior authorization requests to determine coverage outcomes for post-acute services.
Is NaviHealth a public or private company?
NaviHealth is a private company. It is classified as corporate owned and is currently operating.
When was NaviHealth founded?
NaviHealth was founded in 2012. It employs 1,001 to 5,000 people.
Where is NaviHealth based?
NaviHealth is headquartered in Brentwood, United States, in the North America region.
How does NaviHealth make money?
One revenue line is on record: healthcare administrative services.
Who are NaviHealth's main competitors?
Emerging players on record are HHAeXchange, MatrixCare, AlayaCare and PointClickCare. Direct peers are AIM Specialty Health, CareCentrix, WellSky, MCG Health and eviCore healthcare. Modivcare is listed as a broad incumbent.
Does NaviHealth have an API?
No public API is recorded for NaviHealth.
What industry is NaviHealth in?
NaviHealth's product category is Post-Acute Care Management. Its primary akta.pro industry code is HLALABAG, Post-Acute & Transitional Care Virtual Platforms (SNF/home health coordination), with a secondary code of HLALACAG, Post-Acute, Transitional Care & Readmissions Virtual Programs (Payer-Sponsored). Its NAICS code is 62412 and its SIC code is 8000.