Wikia

Psychology Wiki

Utilization management

Talk0
34,117pages on
this wiki
Revision as of 11:02, November 27, 2012 by Dr Joe Kiff (Talk | contribs)

(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

Assessment | Biopsychology | Comparative | Cognitive | Developmental | Language | Individual differences | Personality | Philosophy | Social |
Methods | Statistics | Clinical | Educational | Industrial | Professional items | World psychology |

Clinical: Approaches · Group therapy · Techniques · Types of problem · Areas of specialism · Taxonomies · Therapeutic issues · Modes of delivery · Model translation project · Personal experiences ·


In health care utilization utilization management is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. Typically it includes new activities or decisions based upon the needs assessment.

Utilization management describes proactive procedures, including discharge planning, concurrent planning, pre-certification and clinical case appeals. It also covers proactive processes, such as concurrent clinical reviews and peer reviews, as well as appeals introduced by the provider, payer or patient.

As pre-certification and concurrent review of cases grew, utilization management spun out of utilization review.

While not synonymous, health care professionals tend to use the terms as interchangeable. The difference is utilization management is forward looking and intends to manage health care cases efficiently and cost effectively before and during health care administration. Utilization review is more backward looking considering whether health care was appropriately applied after it was administered.

There are four basic techniques in utilization management: Demand Management

Disease Management

See alsoEdit

This page uses Creative Commons Licensed content from Wikipedia (view authors).
Advertisement | Your ad here

Around Wikia's network

Random Wiki