CHICAGO, Sept. 16, 2026 (GLOBE NEWSWIRE) -- R1 (“R1” or the “Company”), the leader in healthcare revenue management, today announced Phare Utilization Management (“Phare UM”), a new AI-powered solution designed to help health systems move utilization management from a retrospective review process to a proactive, real-time clinical and financial decisioning function. Unlike traditional utilization management processes that focus limited resources on a small subset of admissions, Phare UM continuously evaluates every patient encounter from admission through discharge, helping teams apply clinical judgment while identifying payer risk to prevent medical necessity denials. The Guthrie Clinic is among the first health systems adopting Phare UM to align utilization decisions with clinical necessity, strengthening utilization management and proactively reducing avoidable denials.
As hospitals face growing financial pressure from rising denial rates, utilization management leaders are being asked to make faster, more consistent, and more defensible decisions throughout the patient stay—all while navigating increasing payer complexity, constrained clinical capacity, and time-intensive manual review processes. Phare UM helps organizations proactively identify admissions that payers may challenge, understand why and act while clinical documentation can still be influenced.
Built on Phare OS, Phare UM moves utilization management beyond reactive worklist review to a connected decision system where AI agents apply clinical judgment, assess denial likelihood and generate quantified recommendations using R1’s proprietary historical observations of real-world outcomes. Phare UM continuously reviews 100% of cases from admission through discharge, surfacing payer-specific risk and documentation gaps within a utilization management team’s existing workflow, reducing the need for manual chart review. The solution combines AI-driven clinical intelligence, predictive payer-risk insights and intelligent workflows to help utilization management teams focus their expertise where it can have the greatest impact. In a sample assessment for one customer, Phare UM found that approximately 65% of observation encounters should have been billed as inpatient status, demonstrating opportunities to reduce revenue leakage, improve status accuracy and reimbursement performance.
“Healthcare organizations have too many critical decisions occurring in disconnected workflows across the patient and financial journey,” said Joe Flanagan, Chief Executive Officer of R1. “Our vision for Phare OS is to create the industry's most intelligent and integrated pre-bill architecture, connecting the revenue cycle through a shared foundation of clinical, financial and operational intelligence. Phare UM brings that vision to life in utilization management by helping organizations reduce friction, spot risk sooner, close documentation gaps earlier, and reduce avoidable medical necessity denials.”
Phare UM Extends Phare OS Pre-Bill Architecture to Strengthen Utilization Management
- Grounded in clinical judgment, informed by reimbursement risk: Phare UM evaluates every case using Phare Intelligence, guided by clinical judgment, then layers in payer-specific risk through Payer Atlas and calibrates recommendations to each health system's clinical policies, payer mix and denial tolerance. This enables utilization management teams to see which cases need attention first, rather than working through a queue in admission order. By combining clinical and denial-likelihood signals, Phare UM surfaces risk that clinical criteria alone may not catch.
- Connected utilization management workflows across the patient stay: Phare UM connects the utilization management process across the patient stay so relevant context carries forward across review, escalation, care team input, and downstream denials. Instead of piecing together information from multiple systems, utilization management teams can see the full history of a case in one workflow and build stronger rationale for the next review, escalation or appeal. By reducing disconnected workflows and using outcomes to inform future decisions, teams can build a stronger payer-facing rationale while helping reduce the cost-to-collect.
- AI-enabled insights supported by clinical expertise: Phare UM pairs AI-enabled signals and insights with clinical human expertise to surface cases where escalation or intervention may be needed. Utilization management teams receive prioritized worklists and evidence-based recommendations and gain visibility into cases most likely to warrant escalation, keeping human judgment at the center of every decision.
“As Phare OS continues to expand across the pre-bill workflow, we're seeing firsthand how connected intelligence strengthens utilization management,” said Dr. Jennifer Weinberg, Vice President of Physician Advisory Solutions at R1. “Our physician advisors are already using Phare UM in active case reviews and peer-to-peer workflows, and the early feedback is positive. By surfacing the right clinical and payer insights at the right time, Phare UM helps clinicians spend less time gathering information and more time making complex statusing decisions.”
About R1
R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. A pioneer in the industry, R1 created the first Healthcare Revenue Operating System: a modular, intelligent platform that integrates automation, AI, and human expertise to strengthen the entire revenue cycle. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 U.S. health systems, and handles over 600 million payer transactions annually. This scale provides unmatched operational insight to help healthcare organizations unlock greater long-term value. To learn more, visit: r1rcm.com.
Contacts
R1
Mike Gilhooly, Director of Public Relations and Communications
media@r1rcm.com
