Jiva PrudenceAI
Jiva PrudenceAI is ZeOmega®’s intelligence and experience orchestration platform for healthcare operations. PrudenceAI adds an intelligence layer over healthcare management platforms like Jiva. It connects through the HealthUnity HealthConnect Fast Healthcare Interoperability Resources (FHIR®) hub, so health plans can bring artificial intelligence (AI) into utilization management (UM), prior authorization, and care management (CM) workflows.
AI creates value for health plan teams when it shows up inside the work they already do — the authorization request, the clinical review, the member outreach call. PrudenceAI uses agentic frameworks, FHIR repositories, and semantic networks to drive intelligence in care quality, risk, and cost management, with configured policies and human review governing how AI is applied.
What Does Jiva PrudenceAI Do?
PrudenceAI brings AI applications, workflow solutions, data, and governance together on one platform:
- ClicBank Studio and App Marketplace: Lets health plans explore, evaluate, and deploy PrudenceAI applications, then embed the apps they select directly within Jiva workflows and business processes
- Bring Your Own AI (BYoAI): Connects client-approved AI models and applications through FHIR, workflow, event stream, and policy interfaces
- Smart UM for Utilization Management and Prior Authorization: Automates UM and prior authorization workflows with digital authorization intake, medical guideline assistance, structured policy digitization, decision support, fax automation, and Smart Writing Assistant, delivered through the Smart UM Suite
- Smart CM for Care Management: Increases care management productivity with AI-driven call and clinical summarization, recommended next-best actions, and CM Assist
- Jiva Data Fabric: Connects clinical, operational, administrative, and external data sources into a unified intelligence foundation with a comprehensive, real-time view of each member
- Enterprise AI Infrastructure: Powers scalable data processing and governed AI workloads through a Databricks-based Microsoft Azure Lakehouse and enterprise large language model (LLM) infrastructure
- Partner Program: Extends PrudenceAI through ZeOmega’s certified partner ecosystem for secure, standardized integration with third-party AI platforms and technology solutions
How Does Jiva PrudenceAI Support Health Plans?
- AI Embedded in Daily Operations: Delivers summaries, recommendations, and prepared actions directly within Jiva workflows
- Member Insights Turned Into Workflow Action: Combines FHIR clinical data, Jiva member and episode data, risk scores, high-risk cohorts, chronic conditions, policies, and case context
- Higher UM and CM Productivity: Automates workflows to accelerate decisions, reduce manual effort, and expand staff capacity
- Governed AI Execution: Supports governed AI through configured policies, models, prompts, permissions, validation, and human review
- Scalable AI Adoption: Adds AI capabilities by selecting PrudenceAI apps from the ClicBank Studio catalog or connecting approved client AI through BYoAI application programming interfaces (APIs)
Who Does Jiva PrudenceAI Help?
PrudenceAI supports the teams that run health plan operations, including:
- Health plan executives and operations leaders
- UM nurses, clinical reviewers, and medical directors
- Care and case managers
- Population health, quality, and clinical policy teams
- Product, workflow, integration, and data teams
- Provider network managers, patient access teams, revenue cycle administrators, and referral coordinators
Download the Jiva PrudenceAI product overview to explore features and benefits.
Additional Resources
Solution: Smart UM Suite
Solution Trends: Smart Auth Optimizer
Solution Trends: The Smart Fax Automator
Solution Trends: Medical Guidelines Digitizer (MG Digitizer)
Solution Trends: HealthUnity ZeOmega’s Interoperability Solution
News: ZeOmega Earns Artificial Intelligence Accreditation from DirectTrust®
Webinar: Near Real-Time Prior Authorizations With AI