Utilization Review Nurse AI-AI-Powered Clinical Review

Example

Evaluating a patient's laboratory results and vital signs to recommend the most appropriate care setting.

Scenario

For a patient with chest pain, the AI might analyze EKG results, cardiac enzyme levels, and clinical presentation to recommend observation status while awaiting further diagnostic tests.

Example

Determining the necessity of inpatient admission versus outpatient management for a patient.

Scenario

In the case of a patient with a mild pneumonia, the AI could suggest outpatient treatment with oral antibiotics, while for a more severe case exhibiting respiratory distress, it would recommend inpatient care.

Example

Creating concise, evidence-based reports that justify the recommended level of care for insurance purposes.

Scenario

After deciding on inpatient care for a patient with severe pneumonia, the AI generates a report outlining the clinical findings and guideline-based recommendations to support the necessity of hospital admission for insurance approval.