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https://www.trilliumadvantage.com/content/dam/centene/trillium/advantage/pdfs/Clinical-Criteria-for-Utilization-Management-Decision-Making-Procedure-Trillium.pdf
Trillium: Clinical Criteria for Utilization Management Decision Making Procedure Page 1 of 4 A. Purpose The purpose of this procedure is to provide a set of evidence-based clinical decision making criteria for Trillium Community Health Plan (Trillium) Utilization Management (UM) staff making
https://link.springer.com/chapter/10.1007/978-3-319-34199-6_4
Dec 01, 2016 · Abstract. Informatics underlies some of the most effective laboratory utilization management tools. For example, computerized provider order entry systems often offer clinical decision support functionality that utilization management teams can leverage to provide clinicians “just-in-time” test-ordering advice and alerts.Author: Jason Baron
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195135/
Utilization management programs. UM as used in this article is: “… a set of techniques used by or on behalf of purchasers of health benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care …”Cited by: 11
https://healthitanalytics.com/features/understanding-the-basics-of-clinical-decision-support-systems
Dec 12, 2017 · Understanding the Basics of Clinical Decision Support Systems ... in part to encourage the development of new CDS tools that could help support population health management, precision medicine, value-based care, patient safety, and operational efficiencies. ... Clinical decision support tools can only improve patient safety and care quality if ...
https://www.healthcareitnews.com/news/reinventing-utilization-management-um-bring-value-point-care
Sep 18, 2017 · The result is a new form of utilization management (UM) that shifts the balance of interactions from post-care decision with claims to pre-care decisions. ... processes and tools needed to deliver cost-effective, evidence-based quality care. ... Nilo Mehrabian: Vice President, Product Management, Decision Support, Change Healthcare. Nilo ...
https://aspe.hhs.gov/report/short-term-analysis-support-mental-health-and-substance-use-disorder-parity-implementation/utilization-management-um-practices
UM refers to the policies and protocols that define when and for what types of services preauthorization, concurrent review,and retrospective review are utilized. The review provides the opportunity for medical necessity criteria to be applied. Thus, the review may result in denial of coverage for all or some portion of care, or authorize coverage for an alternative to the requested care.
https://www.researchgate.net/publication/257300513_The_role_of_informatics_and_decision_support_in_utilization_management
The role of informatics and decision support in utilization management. ... synoptic reporting in pathology has become more widely utilized, particularly based on a major effort by the CAP Cancer ...
https://www.paramounthealthcare.com/assets/documents/provider/Utilization-Mgt-Program.pdf
the utilization management functions and tools/guidelines described above. ... To assure fair and consistent Utilization Management decision-making. ... Coordinators, Care Management Project Coordinators, Utilization/Case Management Staff Support and Utilization/Case Management Departmental Support. The Disease
https://casemanagementstudyguide.com/ccm-knowledge-domains/healthcare-reimbursement/utilization-management/
Utilization Management- Review of services to ensure that they are medically necessary, provided in the most appropriate care setting, and at or above quality standards. Utilization Review- A mechanism used by some insurers and employers to evaluate healthcare …
https://en.wikipedia.org/wiki/Utilization_management
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided …
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