Utilization Management (UM) Program Development
A comprehensive UM program has multiple components such as:
- implementation of a UM Committee and Workgroup Infrastructure;
- gathering information intelligence to reveal care and resource utilization patterns of providers and patients,
- developing key UM methodologies such as Pre-authorization Processes for Elective Admissions; Referral Management Programs for Primary Care and In-hospital Utilization Review/Case Management Processes
- benchmark utilization management performance of providers