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Prioritization Automation in Utilization Management

Increased Demand for Sorting and Prioritization Automation in Utilization Management

Role of Jiva’s Robust Business Intelligence Tool

There is an ever-increasing demand in health plans for sorting and prioritizing prior authorizations and improving utilization management. Payers often try to utilize effective Microsoft tools and PHM software to perform such automation, but ZeOmega offers a tool like no other.  

Over the past few years, many of our clients have learned to leverage Jiva’s Sentinel Rules Engine (SRE), ZeOmega’s proprietary business intelligence tool. The robust solution effectively prioritizes, sorts, and evenly distributes episodes among available staff with consideration to their workload, calendar availability, and performance.

Jiva’s SRE is a comprehensive business intelligence tool that allows clients to define their business needs in the form of scenarios—both positive and negative—which can then be drilled down to application triggers, a set of criteria and required actions that need to be automatically performed when the scenario is encountered in Jiva (in near real time) without impacting the application performance, thereby not impacting Jiva users.

The percentage of Jiva users leveraging our business rules is increasing with each implementation, giving all our clients and prospects more confidence to rely on our platform’s automation to effectively prioritize, sort, and manage the case load.

The following are some criteria Jiva SRE considers when sorting and prioritizing episodes:

  1. Episodes with an urgent request.
  2. Episodes with an overdue date.
  3. Episodes with an immediate due date today.
  4. Episodes with an immediate due date tomorrow.

Our SRE is smart, quick, and accurate while also saving you from having to remember non-health related issues that may affect priorities. For instance, while sorting episodes on Fridays, or any days that land just before the holidays, Jiva SRE automatically picks up the episodes the very next business day and sorts them accordingly. It automatically loads the episode in the correct hierarchy order, saving you time, errors, and money.

The above is one good example of a Jiva SRE automation benefit regarding episode sorting and prioritizing, but there are many. Our SRE is totally configurable, and clients can define their own criteria per their business requirements and use this feature to enhance productivity, review cases that require utmost attention, and efficiently manage the case load. And the list of benefits goes on from there. Jiva SRE is exactly the kind of tool that instantly helps payers provide better care and stay organized.