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| Utilization Manager |
| Improve utilization review workflow and management of covered days and length of stay to prevent denied days and reduced reimbursement. |
- Provides real-time patient financial information and reports to promote effective case management
- Manages length of stay with a concurrent, proactive approach
- Assigns accountability on a per diem level for efficient denial management and distributes cases to the right people regardless of location
- Improves patient throughput by tracking and routing avoidable days and prompts users as cases meet and exceed the targeted length of stay to reduce retrospective denials
- Facilitates action on denied and/or downgraded days while patient is in-house
- Provides reports to access appeal and overturn percentages by payor
- Customizes workflow based on specific business requirements
- Integrates data and processes across disparate systems at key points in workflow
- Provides senior-level personnel access to case management information for review and decision-making
- Offers a separate work queue for physician advisors and medical directors for reviewing and overturning concurrent denials
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