Utilization review services to improve staffing shortages and competing workflows
Many acute care hospitals have been experiencing staffing shortages and challenges managing an efficient utilization management team. Pair those staffing shortages with competing clinical priorities and the result is disjointed workflows, poor utilization management outcomes and added financial strain.
From day one with Optum® Integrated Utilization Management Service, you can have peace of mind knowing your utilization management function is fully covered.
Transform your utilization management (UM) operations
Flexible, compliant UM
Tailored utilization management services
Blends evidence-based criteria, technology and services into tailored solutions.
Predictive insights
Predictive insights identify opportunities and interventions
Predictive insights identify opportunities and interventions by payer, physician, and facility.
Optimize workforce
Optimize your workforce and alleviate staffing pressure
Alleviate staffing pressure with services delivered by UM experts.
AI-driven tech
Exception-based AI technology
Better defensibility from objective criteria and citations to supporting peer-reviewed research.
Key benefits
Comprehensive services
Provides all facets of UM operations through comprehensive UM service model
Drives financial integrity
Drives financial integrity through technology-enabled, best practice UM operations
Reduces expenses
Shields clients from unpredictable, costly expenses such as overtime, contracted resources and fluctuating coverage needs
Efficient review turnaround time
Our unmatched technology drives evidence-based case reviews, efficient review turnaround time and issue resolution
Redeploy clinical staff
Enables redeployment of clinical staff who have been performing UM functions to other critical areas of need
No, our team is familiar with using industry-standard evidence-based guidelines. We will use your preferred tool to perform reviews.
Optum Integrated Utilization Management Nurse Service is an outsourced service model that provides pre-procedural checks, admission and continued stay reviews, and payer authorizations and communications. This service can work directly with your onsite physician advisor resources for case escalations and physician review needs.
Our robust technology platform combines Optum proprietary evidence-based content and AI-enabled workflows to drive our best-practice review processes. You benefit from the reliability and efficiency that these tools offer. Increased visibility into your review process is made available through meaningful client-facing reporting
Optum has been in the UM review space for over 20 years and has conducted over 1 million reviews. Our skilled clinicians undergo continual content and compliance training, and quality reviews to stay up to date with industry knowledge. They apply this expertise to each review. As a client, you benefit from our unwavering commitment to our UM review staff.
Optum UM services operate around the clock to deliver quality service and ensure you have the coverage you need.
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Product information and resources
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Integrated Utilization Management Service
Integrated Utilization Management Service sell sheet
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Physician Advisor Service
Physician Advisor Service sell sheet