Agents that learn your UM nurses.
Concurrent and continued-stay reviews recur on a clock, and each one repeats the same gathering. The agent learns what your nurses look for and has it waiting.
Where the time goes
Clinical records arrive through provider portals and faxes before criteria can be applied. Continued-stay reviews recur on a clock, repeating the same gathering every time. Determinations and member notices get documented across several systems after the call is made.
What the agent takes on.
Learns which findings move your nurses to approve, pend, or escalate for a given presentation Gathers the stay and the clinical record the nurse would have gathered Retrieves the applicable criteria set and applies it to the case Applies the criteria and lays out what the record supports, with its reasoning attached Files the decision and generates the notice once the nurse signs
Where your nurses decide
The agent applies the criteria and shows what the record supports, with its reasoning. The nurse decides on that evidence You set the guardrails: level of care, case type, or confidence level can require a nurse’s signature Adverse decisions stay with a medical director, as regulation requires The event trace shows what was gathered, which criteria were applied, and why it landed where it did