Utilization Management

Prior auth · Length-of-stay management · Concurrent review · Retrospective review · Case conferences · InterQual/MCG criteria

Active Reviews

4

Avg ALOS

5.8d

target 5.2d

Denials YTD

42

Appeal Win Rate

74%

Readmission Rate

8.4%

Active Inpatient Reviews

UM001

Ahmad Al-Rashid

Bupa

Current LOS

8d

Expected

5d

InterQual met

Concurrentapproved

UM002

Fatima Al-Zahra

Tawuniya

Current LOS

4d

Expected

7d

Approved 4 more days

Concurrentapproved

UM003

Khalid Al-Dosari

MedGulf

Current LOS

12d

Expected

5d

⚠ LOS exceeds criteria

Concurrentunder review

UM004

Sara Al-Ghamdi

Daman

Current LOS

6d

Expected

6d

Discharge planning

Concurrentdischarge planning

UM005

Omar Al-Shehri

Aetna

Current LOS

14d

Expected

7d

Denial — observation

Retrospectivedenied