Utilization Management

Green Clock Hours: 10.00

Over recent years, the healthcare management industry has seen dramatic changes. Among them are the function and role of utilization management, which has evolved as a system to evaluate medical necessity and appropriateness of care related to optimal outcomes. The terms utilization review and UM are often used interchangeably. UR is the process of reviewing use, delivery and cost effectiveness of healthcare provided. UM uses the same process, but encompasses additional functions, including processes that improve patient outcomes and resource utilization. UM monitors appropriateness of care, resource allocation and demonstration of medical necessity using specific criteria. This course describes the origins and purpose of UM, including a comparison of concurrent and retrospective review. It also provides an overview of UM roles and responsibilities and defines medical staff‘s responsibility for the process.

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$128.00

Course Description

Over recent years, the healthcare management industry has seen dramatic changes. Among them are the function and role of utilization management, which has evolved as a system to evaluate medical necessity and appropriateness of care related to optimal outcomes. The terms utilization review and UM are often used interchangeably. UR is the process of reviewing use, delivery and cost effectiveness of healthcare provided. UM uses the same process, but encompasses additional functions, including processes that improve patient outcomes and resource utilization. UM monitors appropriateness of care, resource allocation and demonstration of medical necessity using specific criteria. This course describes the origins and purpose of UM, including a comparison of concurrent and retrospective review. It also provides an overview of UM roles and responsibilities and defines medical staff‘s responsibility for the process.

Only $249
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Only $249