utilization review


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Related to utilization review: Drug Utilization Review

utilization review

n.
A process for monitoring the use and delivery of services, especially one used by a managed care provider to control health care costs.

utilization review

Utilization control, utilization management Managed care Evaluation of the necessity–eg, for surgery or other therapy, appropriateness–of admissions or of services ordered, and efficiency of the use of health care services, procedures, and facilities. See Utilization.

utilization review

Evaluation of the necessity, quality, effectiveness, or efficiency of medical services, procedures, and facilities. In regard to a hospital, the review includes appropriateness of admission, services ordered and provided, length of stay, and discharge practices.
References in periodicals archive ?
The PCP agreement discloses the physician's capitation fees, the services he or she is expected to perform, and his or her responsibilities relating to utilization review and management.
Further research is needed that takes advantage of larger numbers and more detailed and recent clinical information in order to definitively elucidate any relationship that might exist between utilization review decisions and quality of care.
Fortunately, managed care organizations (MCOs) integrated quality with utilization review as a model for utilization management in the late 1980s.
Even though job descriptions were written so that communication and interpersonal skills were required, a plan was formulated to educate the care coordinators in these personal growth skills as well as assertiveness, interpersonal problem solving, and the financial skills of utilization review, admission authorization, and discharge planning.
Clearly, the risk of managed health care litigation is an ever-present danger for corporations that use managed care or utilization review. In addition to the Health Net case, hundreds of other cases have appeared in recent years.
Every time he goes to the hospital, this man must notify the utilization review company.
California State Fund Launching Utilization Review Solution
Utilization review (UR) has become a hot issue in workers compensation recently, with states such as California making changes to its regulations in an attempt to reduce treatment delays and ensure quality by requiring utilization review organizations (UROs) to attain accreditation.
David Allara, MD is known in the addictions industry for his work in the billing and Utilization Review Departments of drug and alcohol treatment centers.
Weinman is a charter diplomate of the American Board of Family Practice and board certified in quality assurance and utilization review. He is also a Certified Healthcare Compliance Officer.
Utilization review in workers' compensation is one of the many tools we have available to ensure that an injured employee receives the best, most appropriate medical care necessary to achieve a quick and sustainable return to work.