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What Is Utilization Management
Utilization Management (UM) is a method used to manage the use of health care resources. It monitors and evaluates proposed medical treatments and services for appropriateness, cost-effectiveness, quality, and resource utilization. UM also helps ensure that members receive medically necessary care in an optimal setting. This helps control unnecessary costs while maintaining member access to appropriate care. By using data driven analytics and evidence-based medicine criteria, utilization management strives to promote safe, effective care with the best possible outcomes. Utilization management plays a critical role in helping healthcare providers improve patient outcomes by ensuring that preventive services are provided at the right time, as well as preventing high costs from being incurred due to inappropriate or unnecessary procedures. Ultimately, UM works to achieve better value for the healthcare system, while still providing quality services and care to patients. It also helps reduce medical errors, improve patient safety and satisfaction, increase efficiency and help manage health costs. Utilization management is a critical element in ensuring access to effective, high-quality healthcare for all.
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