Utilization Review

Supervised AI agents for utilization review.

UR nurses spend review time gathering instead of reviewing: pulling clinical data, assembling documentation, and updating case systems after each determination.

Today

Where the time goes

Chart data is assembled from EHR work queues before criteria can even be applied. Determinations are documented in multiple systems after the clinical call is made. Continued-stay reviews recur on a clock, and each recurrence repeats the same gathering work.

With ModelNex

What the agent takes on.

Opens the case in the review queue and gathers stay and clinical data Retrieves relevant protocols and criteria references through your MCP tools Pre-fills the review template with the assembled case data Routes the prepared case to the nurse for determination Files the determination across systems once the nurse decides

Your team

Where clinicians stay in the loop

The nurse makes every determination; the agent never applies clinical criteria The agent prepares and files, and pauses for review at each configured step The event trace shows exactly what was gathered and filed for each case