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.
As health plans and providers transform operations to support value-based care, it’s important to keep in mind that successfully engaging consumers in their health is also critical to managing costs and outcomes.
Join ZeOmega experts as they discuss how health-related social need (HRSN) interventions and/or programs can be utilized to advance health equity through the lens of an integrated delivery network.
How will AI change the future of care management? Learn about the impact of ChatGPT/AI in Healthcare
The Jiva Care Quality (CQ) Navigator is a powerful performance monitoring and analytical solution with an embedded omnichannel workflow that centralizes HEDIS and CMS Stars quality program data, improves care gap closure rates, and empowers value-based care reporting.
ZeOmega announced that it has integrated its SDOH Social Care solution with Microsoft Cloud for Healthcare built for Microsoft Azure.