The Challenge
RN Supervisors at this healthcare payer spent thousands of hours annually identifying and assigning members eligible for case management. This manual process was both time-consuming and resource-intensive.
The Solution
Amitech, a Naviant Company, and the payer collaborated to automate the case management assignment process using an unattended RPA bot to streamline operations. The bot analyzes member lists from a Snowflake data table, categorizing them as eligible, non-eligible, or missing phone numbers. Eligible members are then auto-assigned to clinical staff based on specific business rules, including availability, specialty, and location. This ensures maximum RN utilization. The bot assigns members to RNs in Affinite weekly, adhering to capacity limits set by supervisors.
Implementation
The process for implementation is as follows:
- Snowflake (Data Table): The bot sorts the member list from Snowflake, determining members eligible for case management.
- Member Assignment: Eligible members are auto assigned to clinical staff based on pre-set rules.
- Affinite (Care Management): The bot creates and assigns tasks to RNs in Affinite. Member Management Forms (MMF) are created as part of task assignment.
