Utilization Management

The Utilization Management (UM) capabilities in Jiva give organizations the insights and tools needed to better guide the use and effectiveness of healthcare services. Users can gauge medical necessity and appropriateness of care, and review care assessments, stay requests, and procedures. The system can trigger real-time auto adjudication based on pre-configured or client-defined rules, and supports provider self-service, giving providers the ability to enter authorization requests via multiple methods and obtain real-time approvals. Concurrent review and medical director review for inpatient and outpatient episode types are made easy, while a multi-services review-on-a-click enables faster turnarounds.

Jiva UM also supports behavioral health for inpatient, outpatient, and full utilization management services, such as prior authorization, referral, concurrent review, and cost savings management, as well as the ability to conduct behavioral health assessments.

Optional integrations with MCG Cite AutoAuth and Change Healthcare InterQual Connect Medical Review Service for clinical evaluations are also offered.