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From Promise to Practice: How AI is Transforming Hospital Utilization Management
Activity description
In today’s complex landscape of hospital utilization management (UM), the strategic application of artificial intelligence (AI) and automation is critical to driving meaningful improvements. However, the rapidly expanding array of vendors, technologies, and promises has made it increasingly difficult for organizations to identify which solutions best align with their specific needs. To navigate this complexity, it is essential to bring awareness of the various types of AI and their optimal use cases within the UM workflow. Decision-makers will then be better equipped to evaluate and integrate the right technologies into their organizational strategies and ultimately enhancing UM efficiency, reducing administrative burden, and minimizing denials.
This activity is designed to meet the educational needs of nurse practitioners, nurses, PAs, case managers, physicians, psychologists, social workers, and other HCPs who have an interest in the role of artificial intelligence (AI) and the appropriate use cases in hospital utilization management (UM).
At the end of this activity, participants should be able to:
- Differentiate between key AI technologies such as Robotic Process Automation (RPA), Natural Language Processing (NLP), Large Language Models (LLMs), and Generative AI and identify appropriate use cases for each within hospital utilization management (UM).
- Analyze real-world applications of AI and automation in UM workflows, including case stratification, prioritization, medical necessity reviews, and physician advisor support.
- Evaluate the impact of AI-driven solutions on reducing administrative burden, mitigating clinician burnout, and enhancing revenue integrity in healthcare organizations.
Provided by
This activity is provided by Optum Health Education and Optum Insight.
Commercial support
No commercial support was received for this activity.
Required hardware/software
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Presenter
Alex Yerukhimov
Director, Product Management
Optum
Activity planners
Rebecca Gleason
Clinical Activity Manager
Optum Health Education
Andrea Keenan
Director, Product Marketing
Optum Insight
Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, Optum Health Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.
The presenter and activity planners have no financial relationships to disclose.
Accreditation statement
In support of improving patient care, this activity has been planned and implemented by Optum Health Education and Optum Insight. Optum Health Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.
Credit designation statements
Nurses
The participant will be awarded up to 1.00 contact hour(s) of credit for attendance and completion of supplemental materials.
Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.
Physicians
Optum Health Education designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
PAs
The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.
Social workers
As a Jointly Accredited Organization, Optum Health Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Optum Health Education maintains responsibility for this course. Social workers completing this course receive 1.00 live continuing education credits.
Counselors and/or marriage and family therapists
CA: The Board of Behavioral Sciences has deferred CE course approvals to APA and ASWB for its licensees. See those approvals under Psychologists and Social Workers.
Other States: If your state is not specifically listed, nearly all state Counselor and MFT boards accept either APA or ASWB approval, or are reciprocal with other state licensing board approvals. Check with your board to be sure.
AAPC-certified coders
AAPC will honor 1-for-1 CEUs for any live event offering CME credit or AMA PRA Category 1 Credit™. A certificate of attendance or completion is necessary to show participation. The certificate will give the total CMEs possible for the offering. Physicians are advised to claim only the actual hours that they were present during the education. We ask that AAPC-certified members abide by this request also. One hour of instruction is worth 1 CEU.
Attendance
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been preapproved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization from which they wish to obtain credit.
Available Credit
- 1.00 AMA - Physicians
- 1.00 ANCC - Nurses
- 1.00 Attendance - General Attendance
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