Utilization management has been digitized, but it has not yet been fully transformed. Many organizations still rely on episodic reviews, broad work queues and disconnected escalation processes-- making it difficult to identify risk early enough to change the outcome. AI creates an opportunity to move beyond simply automating existing tasks and instead redesign UM as a continuous, connected decision process.

In this session, clinical, health system, and healthcare technology leaders will examine what it takes to build an AI-enabled UM operating model that delivers results. The discussion will explore how continuous case analysis can bring together clinical evidence and payer-specific risk, deliver explainable insights at the point of action and direct limited clinical expertise toward the cases where intervention can have the greatest impact.