utilisation review

(redirected from utilisation management)

utilisation review

Evaluation of the necessity (e.g., for surgery or other therapy), appropriateness (of admissions or of services ordered) and efficiency of the use of healthcare services, procedures, and facilities.

Components
Pre-admission reviews, concurrent (i.e., while patient is in hospital) reviews, reviews of procedures, levels of care and medical necessity after discharge.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.
References in periodicals archive ?
To be awarded NCQA three-year accreditation, the company underwent a rigorous assessment of its systems, processes and personnel in utilisation management to ensure the high standards are met.
Despite having the broadest US formulary coverage of any PCSK9 inhibitor, many patients have been unable to access Praluent because of the complicated utilisation management process required by some insurance companies and high patient out-of-pocket costs.
US-based a healthcare management company Magellan Health, Inc.'s (NASDAQ: MGLN) NIA Magellan solutions unit has entered into a definitive agreement to acquire all of the outstanding shares of stock of US-based cost containment and utilisation management company HSM Physical Health, Inc., the company said.
As part of the company's executive leadership team, Breslav will lead all aspects of the national sales and marketing efforts to drive long-term strategic growth for both its utilisation management and IRO programmes as well as oversee strategic development of its national business presence and account management expertise, reporting directly to its CEO & president Ed Bolton.
According to the company, URAC's Mail Service Pharmacy Accreditation standards cover core organisational quality, customer service, communications and disclosure, drug utilisation management, pharmacy operations, and a process for mail service outcomes measurement and quality improvement.
CHC provides healthcare services, including primary care, dental, behavioral, pharmacy and utilisation management services, to public and private correctional facilities in 26 US states.
URAC's Health Utilisation Management Accreditation reportedly ensures that all types of organisations conducting utilisation review follow a process that is clinically sound and respects patients' and providers' rights, address the use of evidence-based guidelines, outline specific reviewer requirements for each level of review and require a policy preventing financial incentives to doctors and other providers based on consumers' use of health services as well as meet the demands of a changing healthcare system.
The Essette core technology platform includes case management, utilisation management and population health management which collectively enable collaboration and facilitate best practices for payers across the care continuum.
Presently, she is senior vice president responsible for Quality Management, Utilisation Management, Provider Credentialing, and Government Programmes.
Effective 30 August 2016, Dr Leenay will oversee the the company's model of care and care management programmes, increase the efficiencies and effectiveness of clinical outcomes, as well as work closely with the executive team, the chief medical directors of utilisation management and quality, the local markets and key nurse executives to inform the fundamental elements of its clinical strategy.
20 January 2015 - US-based a healthcare management company Magellan Health, Inc.'s (NASDAQ: MGLN) NIA Magellan solutions unit has entered into a definitive agreement to acquire all of the outstanding shares of stock of US-based cost containment and utilisation management company HSM Physical Health, Inc., the company said.
M2 EQUITYBITES-June 17, 2014-CVS Caremark passes NCQA's Utilisation Management certification