Utilization Review and Management

Optimize care processes to ensure quality outcomes and patient satisfaction

Our platform supports criteria-based reviews for medical necessity, detailed communication with payors, physician advisors, post-acute care providers and others. Using our software will help you avoid unnecessary readmissions by identifying patient populations at risk and providing tools that promote a smooth transition, or hand-off.

Highlights:

  • Instant HL7 messages for updates to patient records in real-time
  • Customize the configured rules for automatic identification of pre-admission, observation, admission, readmission and continued-stay reviews
  • Automates referrals to internal and external physician advisors
  • Provides care assessments, interventions and documentation to ensure continuity of care and effective hand-offs
  • Standardized documentation and clinical information packets for use in payor contacts
  • Variance tracking, including readmission assessments, and avoidable days and delays
  • Integration with Change Healthcare’s Interqual and MCG CareWebQI medical necessity criteria
Utilization Review and Management Dashboard

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