Healthcare Utilization Management
The Utilization Management (UM) capabilities in Jiva give healthcare 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 Utilization Management also supports behavioral health for inpatient, outpatient, and full utilization management services, such as electronic prior authorization, referral, concurrent review, and cost savings management, as well as the ability to conduct behavioral health assessments.
Optional Integrations with Jiva Utilization Management
Optional integrations with MCG Cite AutoAuth and Change Healthcare InterQual Connect Medical Review Service for clinical evaluations are also offered.
Who We Serve
Commercial Health Plans
A one-stop shop for care management, benefits administration, process automation, organizational optimization, and efficiency across the enterprise.
Exceed your value-based care benchmarks leveraging combined clinical and claims data to reduce risk, close gaps, and ensure optimal outcomes.
Accountable Care Organizations
From risk-stratification to gap identification and closure strategies, our capabilities are unmatched, and built in SDOH criteria helps you reach at-risk communities with effective programs.
Medicare Advantage Plans
Built-in risk adjustment to drive consistent success in PMPM payment models and maximize Star ratings performance.
ZeOmega is #1 Best in KLAS for Payer Management Solutions 2022 and 2023
Impact of the New CMS Healthcare Interoperability Rules | ZeOmega
Much of the direction of the 2020 proposed rule is in the new proposed rule, particularly the sharing of prior authorization decisions/status with patients.
AbsoluteCare Selects ZeOmega for Chronic Care Management for High-Risk Patient Populations
ZeOmega announced today that value-based integrated healthcare provider AbsoluteCare has selected ZeOmega’s Jiva platform to fulfill its needs for comprehensive care management, utilization management, and clinical assessment support.