utilization management

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Related to utilization management: utilization review

u·ti·li·za·tion man·age·ment

(yū'ti-lī-zā'shŭn man'ăj-mĕnt)
Review of appropriateness and necessity of care provided to inpatients
References in periodicals archive ?
The former utilization management information system was replaced with an integrated product early this year.
NCQA's accreditation process involved a rigorous review of Premier's Utilization Management and Credentialing functions to ensure that Premier follows processes that respect members' and practitioners' rights, that only appropriately trained and qualified clinical personnel conduct and oversee utilization review, and that medical decisions are based on evidence-based clinical criteria.
Some companies actually got into the business of selling utilization management programs to businesses and to insurance companies.
The issue of legal liability related to utilization management activities was first raised in the California case of Wickline v.
Nationwide Better Health's utilization management program ensures efficient use of employer's health care dollars by providing employees with appropriate care for their conditions through focused utilization review.
Promotional statements may give the impression that utilization management reviewers are biased and/or have hidden agendas.
In this study, about half of the patients had treatment subject to utilization management (52.
This certification from NCQA underscores SMS's commitment to provide effective and appropriate sleep services to our health plan clients, which includes applying consistent and rigorous standards of utilization management," said Tom Gaffney, President, Sleep Management Solutions.
Two future activities are required at the Wetaskiwin Hospital to complete the utilization management process.
We are honored to receive the Health Utilization Management accreditation from URAC," said Roxann Brennfoerder, vice president - group customer relations and operations.
WEST DES MOINES, Iowa, June 30, 2011 /PRNewswire/ -- The Minnesota Department of Human Services has selected IFMC to operate the Medicaid Utilization Management Program for the State of Minnesota.
For payer organizations, the core systems should include systems that support individual and organizational enrollment; management of provider networks, utilization management, and claims processing/adjudication/ payment; and investment portfolio management.