utilization-review-assistant

What problem does it solve?

This Skill assists utilization review professionals in making objective, criteria-based decisions about medical necessity, level of care, and length of stay, reducing manual effort and improving consistency.

Core Features & Use Cases

• Medical Necessity Evaluation: Assesses patient data against InterQual, Milliman, and CMS criteria.
• Level-of-Care Determination: Recommends appropriate care settings (ICU, Med-Surg, SNF, etc.).
• Length-of-Stay Justification: Analyzes current stay against benchmarks and identifies discharge barriers.
• Use Case: A UR nurse can input concurrent patient data to quickly determine if the current inpatient stay is medically necessary and if the patient meets criteria for step-down to a lower level of care.

Quick Start

Evaluate the medical necessity and level of care for the provided patient clinical data.