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.
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Key Features

• Improves automation and efficiency to manage the increasingly complex lines of business and customer requirements, including government-sponsored member populations and behavioral health conditions
• Drives overall effectiveness and efficiency of care management through integration of UM with other care management modules
• Leverages the potential payer-provider collaboration opportunities for data integration like EMR and ADT data as well as bidirectional exchange

Benefits of Utilization Management Tools:

Case Study: Smart Auth Optimizer

Case Study: How a Major Health Plan Streamlined Provider Communications, Improved Internal Processes, and Significantly Enhanced Quality of Care with ZeOmega’s Jiva Provider Portal