utilization-review-assistant

Evaluate medical necessity and level of care against InterQual and Milliman criteria.

1|1|Updated Feb 19, 2026

Search Tags:#healthcare #medical necessity #utilization review #level of care #InterQual #Milliman #clinical review

Ready to run

npx skills add https://github.com/GoldenZero/skills --skill utilization-review-assistant-goldenzero

💬 Prompt for ChatGPT / Claude Chat▼

Please help me install this Agent Skill.
Skill: utilization-review-assistant
Source: https://github.com/GoldenZero/skills/tree/main/skills/utilization-review-assistant
Command: npx skills add https://github.com/GoldenZero/skills --skill utilization-review-assistant-goldenzero

SYSTEM DOCUMENTATION & REQUIREMENTS

💡 This Skill includes assets (resource) and references (resource) components.

What problem does it solve?

This Skill assists utilization review professionals in making objective, criteria-based decisions about medical necessity, level of care, and length of stay, reducing manual effort and improving consistency.

Core Features & Use Cases

Medical Necessity Evaluation: Assesses patient data against InterQual, Milliman, and CMS criteria.
Level-of-Care Determination: Recommends appropriate care settings (ICU, Med-Surg, SNF, etc.).
Length-of-Stay Justification: Analyzes current stay against benchmarks and identifies discharge barriers.
Use Case: A UR nurse can input concurrent patient data to quickly determine if the current inpatient stay is medically necessary and if the patient meets criteria for step-down to a lower level of care.

Quick Start

Evaluate the medical necessity and level of care for the provided patient clinical data.

Frequently Asked Questions about utilization-review-assistant

High-intent search queries and answers about installing and using this skill.

FAQPage Schema

How do I evaluate medical necessity for inpatient admission using InterQual and Milliman criteria?▼

Medical necessity evaluation is performed by inputting structured clinical data, admission details, and treatment plans to assess patient information against InterQual, Milliman, and CMS criteria for objective utilization review decisions.

What is the process for determining appropriate level of care during a concurrent utilization review?▼

Level of care determination analyzes concurrent patient data against clinical criteria to recommend appropriate care settings, such as ICU, Med-Surg, or SNF, evaluating if a patient meets requirements for step-down to a lower level of care.

Can I use this utilization review assistant for retrospective reviews and peer-to-peer appeals?▼

Yes, the utilization review assistant supports retrospective utilization reviews and peer-to-peer appeals by evaluating admission and continued-stay criteria, length-of-stay justification, and medical necessity against structured payer information and clinical benchmarks.

How do I justify a patient's length of stay and identify discharge barriers?▼

Length of stay justification is generated by analyzing the current inpatient stay against clinical benchmarks and treatment plans to determine ongoing medical necessity and identify specific barriers preventing patient discharge.

What clinical data do I need to provide for a utilization review decision?▼

You need to provide structured clinical data, admission details, treatment plans, and payer information to generate a comprehensive utilization review output evaluating medical necessity and level-of-care appropriateness.

Does this tool support both continued-stay criteria assessment and initial admission reviews?▼

Yes, the tool applies admission and continued-stay criteria assessment for concurrent or retrospective utilization reviews, evaluating medical necessity and level-of-care appropriateness throughout the patient stay.