Utilization management

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 analysis of a case.

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.

ee also

* Managed care
* Utilization review
* Case management
* Health insurance

there are four basic techniques in Utilization Management:1. Demand Management2. Utilization Review3. Case Management4. Dieseace Management


Wikimedia Foundation. 2010.

Look at other dictionaries:

  • management — I (directorate) noun administration, administrators, advisers, authority, board, board of directors, bureau, bureaucracy, caretakers, central office, chair, chairmen, command, committee, controllers, custodians, decision making body, directors,… …   Law dictionary

  • utilization — I noun applicability, employability, practicality, serviceability, usability, usefulness II index benefit (betterment), consumption, enjoyment (use) …   Law dictionary

  • Management of obesity — The main treatment for obesity consists of dieting and physical exercise.[1] Diet programs may produce weight loss over the short term,[2] but maintaining this weight loss is frequently difficult and often requires making exercise and a lower… …   Wikipedia

  • Management of borderline personality disorder — The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use. Contents 1 Psychotherapy 1.1 Dialectical behavioral therapy 1.2 Schema therapy …   Wikipedia

  • management — Synonyms and related words: accomplishment, achievement, acme, action, administration, agency, archon, auspices, austerity, austerity program, authority, authorization, be all and end all, blue ribbon, board, board of directors, board of regents …   Moby Thesaurus

  • management of farm animal genetic resources — The sum total of technical, policy and logistical operations involved in understanding (characterization), using and developing (utilization), maintaining (conservation), accessing, and sharing the benefits of animal genetic resources …   Glossary of Biotechnology

  • Использование мощностей (CAPACITY UTILIZATION)  — Степень использования имеющихся производственных мощностей …   Словарь терминов по управленческому учету

  • Отклонение использования (UTILIZATION VARIANCE)  — См. Отклонение постоянных производственных накладных расходов по объему (Fixed Production Overhead Volume Variance) …   Словарь терминов по управленческому учету

  • Стоимость использования (UTILIZATION COST)  — Экономические потери, связанные с использованием имеющегося ресурса или услуги для выполнения какого либо действия …   Словарь терминов по управленческому учету

  • Operating room management — An operating theatre (gynecological hospital of Medical University of Silesia in Bytom) Operating room management is the science of how to run an Operating Room Suite. Operational operating room management focuses on maximizing operational… …   Wikipedia


Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”

We are using cookies for the best presentation of our site. Continuing to use this site, you agree with this.