SUMMARY

BUSINESS PROBLEMS

In a Health Plan that engages in Utilization Management activities, there is usually a team of UM Nurses who decides on the incoming Medical Authorization. The determination is in the form of Approve or Deny. When she is unable to do either because the Authorization is very complex and she does not have all the knowledge or facts to make a call, she sends the Auth to a Resident Physician, who then goes over it and gives her judgment. This helps the Nurse make an official "Determination" on the auth. The Physicians are hectic folks, and they are always on the move or in meetings. Hence, we needed a UX strategy to cater to that persona as well as a product.

OVERALL APPROACH

SOLUTION

I was the Product Owner and Designer on this project. I conceived of the product opportunity, the product roadmap, and the design approach. I researched with internal SMEs, interviews many Medical Review Doctors, and Nurses and came up with an MVP. I then designed the experience, flow, and interactive prototype, which was then used to develop a mobile-based app. I worked very closely with two developers to build this in 4 weeks. The app was developed using React Native so that we can have an offering for iOS and Android.

MD Reviewer Business Journey

The following is a the business context and journey in a Medical Authorization Determination process.

MD Reviewer UX/Engineering Design Session

I worked closely with the developers remotely. Using remote tools we aligned on mock flow and REST API end points. I also directed the stack to be React-Native since we wanted to develop both iOS and Android versions.

MD Reviewer Data Flow

The following representes one cut of the data and task flows. This was based on research with multiple customers and represents the baseline approach that fits into solutioning for all customers as MVP

MD Reviewer App Flow

The following represents the main scenarios of the App flow.