Why has improving #MedicalLossRatio become so difficult? For many health plans, the challenge goes far beyond rising medical costs. #MLR performance is influenced by operational decisions made across the organization—from care management and pharmacy to risk adjustment, quality, network strategy, and member engagement. While cost management remains important, sustainable MLR improvement requires an integrated approach that aligns clinical, operational and financial strategies. In our latest executive perspective, Alerion Advisors, together with Rebellis Group, Advent Advisory Group LLC, and Toney Healthcare, examines the hidden drivers of MLR performance and explores where health plan leaders can uncover opportunities beyond traditional cost-cutting. Read the article →https://lnkd.in/ei3XYmk4
Alerion Advisors
Business Consulting and Services
A family of companies dedicated to delivering unparalleled consulting services across the healthcare spectrum.
About us
- Website
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AlerionAdvisors.com
External link for Alerion Advisors
- Industry
- Business Consulting and Services
- Company size
- 501-1,000 employees
- Type
- Privately Held
Employees at Alerion Advisors
Updates
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2027 MA bids are back in play. For eligible Medicare Advantage organizations receiving higher recalculated #QBP ratings, #CMS has opened a narrow window to evaluate bid resubmission opportunities. #MA plans have days, not weeks, to act. 🔹 Notify CMS of intent to resubmit: June 22 🔹 Resubmit bids: June 29 🔹 Actuarial certification due: July 1 The opportunity extends beyond the rating itself. Plans should quickly evaluate: ✔ Financial impact and rebate opportunity ✔ Data integrity, reporting accuracy and compliance considerations ✔ Clinical and operational readiness to support potential benefit and product changes One opportunity. Three areas of impact. One team. At Alerion Advisors, our advisory, audit validation and clinical experts work together to help health plans assess the full impact and make informed decisions. Contact us to get started 👉 partners@alerionadvisors.com Rebellis Group Toney Healthcare Advent Advisory Group LLC
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Thank you to Alliance of Community Health Plans (ACHP) and Health Plan Alliance for a great week of collaboration at the Medicare Advantage 2026 Summit. We were proud to contribute to the discussion, with Jason Montrie moderating a session on how #MA plans should be thinking about #AI and John A. Selby sharing perspectives on the evolving relationship between MA plans and agents/brokers. As the industry continues to navigate rapid change, we're excited to be part of the conversation in meaningful ways—helping health plans leverage AI strategically while strengthening distribution and engagement models that drive growth. If you'd like to learn more about how Alerion Advisors' integrated platform—bringing together the expertise of Rebellis Group, Toney Healthcare, and Advent Advisory Group LLC—helps health plans move from strategy to execution, we'd love to connect 👉 partners@alerionadvisors.com
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By now, many #MedicareAdvantage leaders have read about the Clover Health ruling. The bigger takeaway? Health plans are navigating increasing pressure from #Stars redesign, #RiskAdjustment changes, #MLR performance, regulatory scrutiny and the rapid evolution of #AI. These challenges don't exist in silos—and neither should the solutions. At Alerion Advisors, our family of brands brings together expertise across strategy, clinical and pharmacy operations, quality, compliance, audit and performance improvement to help health plans navigate what's next. The future belongs to organizations that can adapt, execute and deliver results. Rebellis Group Toney Healthcare Advent Advisory Group LLC Learn more 👉 https://lnkd.in/eH2by72c
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Health plans are under more pressure than ever—margin compression, #CMS scrutiny, workforce challenges, and increasing operational complexity. That’s why we’re excited to welcome Jason Montrie as CEO of Alerion Advisors. His focus: advancing a truly integrated platform across clinical, compliance, quality and strategy—moving beyond fragmented solutions toward something that actually works at scale. This includes the combined strengths of Toney Healthcare, Rebellis Group, and Advent Advisory Group LLC—bringing specialized capabilities together under one platform. Looking forward to what’s ahead. Full announcement ▶️ https://lnkd.in/d5KSJiiF
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As regulatory pressure increases and #priorauthorization timelines tighten, health plans are rethinking how they scale clinical operations. At Alerion Advisors, we’re proud to support organizations navigating these changes through our family of brands, including Toney Healthcare, which focuses on flexible, clinically supported prior authorization and #utilizationmanagement solutions. This is a great perspective on how plans can adapt as #CMS requirements and state oversight continue to evolve.
#Priorauthorization timelines are shrinking — and regulatory pressure is rising. #CMS has reduced standard prior auth turnaround times to 7 days (from 14), with 72 hours for expedited decisions, while states are reinforcing that licensed clinicians must make final #UM determinations. Meeting these requirements takes more than speed — it requires the right clinical oversight and operational flexibility. We help plans adapt with scalable, clinically supported prior auth solutions. Let’s talk about how you have prepared 👉 partners@toneyhealthcare.com
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2026 #CMS audit changes are here — and plans need a full-service partner to be ready. The latest updates from #CMS bring heightened scrutiny to compliance, utilization management and data operations. At Alerion Advisors, our family of companies deliver the full-spectrum support health plans need: Rebellis Group – Compliance strategy, audit readiness, regulatory insights Toney Healthcare – Utilization management operations and clinical staffing (nurses, physicians, reviewers) Advent Advisory Group LLC – Data validation, audit consulting and quality assurance Whether you’re building a stronger UM program, reinforcing clinical coverage, or preparing for the 2026 audit environment, we have you covered. Reach out today to learn how our combined expertise can help your plan succeed in 2026 👉 partners@alerionadvisors.com
#CMS just released its 2026 Program Audit Annual Update — and the changes are BIG. Jordan F., our VP of Compliance breaks down what plans need to start preparing for now. Here are a few of the biggest shifts: 🔹 Audit scoring eliminated 🔹 New condition categories: Observation, CAR, IDS 🔹 CPE focus shifts to real-time operational effectiveness 🔹 Quarterly compliance officer calls introduced 🔹 Refined validation audit requirements 🔹 Heightened UM and coverage oversight (CMS-4201-F) This is one of the most meaningful audit shifts we’ve seen in years — and plans that prepare early will be in the strongest position heading into 2026. 👉 Read Jordan’s full breakdown here: https://lnkd.in/eCDJKj3B
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Toney Healthcare, part of our family of brands, is expanding and currently hiring for several remote clinical and leadership roles — including Physician Reviewers, UM Nurses and Supervisors. Across our organizations, flexibility, purpose and balance are at the heart of our mission to improve healthcare at every step. 👉 Learn more and apply today: https://lnkd.in/eh_DuFQi
Now #Hiring: Looking for a better way to work in healthcare? Join a team that values flexibility, purpose and balance while making an impact every day. We’re currently hiring for Remote: ✅Director of Physician Review Services ✅Utilization Management (UM) Nurses ✅UM Supervisors Make an immediate impact from wherever you are — help ensure members receive the right care at the right time, without sacrificing your own work-life balance. If you or someone you know would be a great fit, we want to hear from you 👉 https://lnkd.in/eh_DuFQi
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You won’t want to miss it—a 5-Star Plan’s perspective in a new #webinar hosted by Rebellis Group, part of the Alerion Advisors family of brands. Register Now 👉 https://lnkd.in/eZNUNGgH
5-Star insights, straight from the source. ⭐ Join us for Leading the Way in STARS: A 5-Star Plan’s Perspective—a new #webinar on what truly sustains top performance. Don’t miss the #PartD segment—we’ll unpack medication adherence, formulary strategy, and pharmacy quality measures. Register Now 👉 https://lnkd.in/eZNUNGgH Speakers: Leslye Roque from Leon Medical Centers, John A. Selby, Candice (. and Caron Wingerchuk
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Our CEO, Betsy Seals, sat down with Sachin H. Jain, MD, MBA, President & CEO of SCAN and John A. Selby of Rebellis Group for the first episode of the Rebellis 1:1 webinar series. Download the full episode on-demand: https://lnkd.in/e9YtQdFe
In our new Rebellis 1:1 on-demand #webinar series, we sit down with top healthcare leaders for candid conversations about the forces shaping the future of #MedicareAdvantage. Episode 1 features Sachin H. Jain, MD, MBA, President & CEO of SCAN, alongside Rebellis Group leaders Betsy Seals and John A. Selby. Together, they unpack: ✔️ The challenges and opportunities facing Medicare Advantage ✔️ The evolving role of brokers in member advocacy ✔️ How not-for-profit plans can stand out in turbulent markets Catch the full on-demand episode here: https://lnkd.in/e9YtQdFe