June 9, 2025
Article: Redefining Utilization Management: The Role of AI
Artificial intelligence (AI) is transforming industries, and healthcare is no exception. In a high-level exploration during the recent webinar “Redefining Utilization Management: The Role of AI, MCG’s Senior Clinical Integration Analyst, Miriam Moerbe, MS, BSN, RN, provided a basic exploration on what AI is, how it relates to healthcare and utilization management (UM), and key considerations when deciding if it’s right for a hospital, health plan, or government organization.
Three types of AI to consider:
- Machine Learning
- This is a type of AI that uses algorithms, rules, and data analysis to make data-driven recommendations.
- Natural Language Processing (NLP)
- This is a computer’s ability to understand text and spoken words in the same way human beings can by extracting symptoms, diagnoses, and treatments from narrative text.
- In broader terms, it is machine learning to understand text and the spoken word.
- Large Language Models (LLMs)
- LLMs are fed enormous amounts of data to learn intricate patterns and nuances.
- By using what it has learned from data, it can predict words and sentences based on probability.
Click Here to Read Full Article