SW-120249 - USA (Texas) - AI-Enabled Utilization Management Solution - Deadline October 20,2026

(1) Vendor needs to provide AI–enabled utilization management solution.– AI–enabled utilization management (UM) solution that integrates with Epic and related enterprise systems to support timely, consistent, and prioritized UM review across inpatient and observation encounters.– Solution should analyze available clinical, utilization, payer, authorization, and encounter data to generate actionable, explainable recommendations for admission status review, continued–stay review, payer authorization needs, and physician advisor escalation.– Solution must present prioritized worklists, explainable AI–generated recommendations, source–data transparency, alerts, audit trails, and dashboards that allow users to understand why a case is prioritized and what action is recommended.– AI–driven prioritization of new admissions, observation encounters, short–stay encounters, continued–stay reviews, and denial–risk cases.– Alerts for delayed reviews, high–priority cases, observation outliers, authorization risk, avoidable denial risk, and cases requiring escalation.– Dashboards and exportable reports for operational monitoring, compliance oversight, performance improvement, and executive reporting.– Platform must provide high availability, disaster recovery, monitoring, support procedures, upgrade management, issue escalation, and service–level reporting.– Solution must maintain complete auditability of AI recommendations, user actions, source data displayed, overrides, and outcome tracking for compliance and quality review.– Real–time or near real–time dashboards for UM operations, leadership reporting, and performance monitoring. (2) All questions must be submitted no later than October 7,2026.(3) The contract period will be for three years.