RFI for Cloud-Based Community Care Referral, Authorization, Utilization Management and Coordination Systems

A public entity in New Jersey is seeking a qualified vendor to deliver a cloud-based system for community care referral, authorization, utilization management, and care coordination. The selected solution must support the development and maintenance of required interfaces to integrate with existing enterprise platforms, such as HSRM, through the use of APIs, Vista patches, and updated middleware components.

Key requirements include the integration of artificial intelligence to optimize workflows related to the tracking and documentation of care coordination activities. The system should facilitate timely decision-making and enhance care delivery by incorporating advanced analytics for examining claims data, medical documentation, care complexity, and risk factors.

The proposed solution must also offer compatibility with other AI tools, utilize machine learning to analyze medical records and flag cases for review, and support both manual and automated workflows. A service-oriented architecture is essential, comprising flexible components, configurable workflows, and robust API capabilities. Additional features should include the provision of referral and authorization data management, as well as an emergency care notification system.