For many health plans, managed care organizations, third-party administrators, and healthcare payers, utilization management review has evolved from a transactional administrative function into a ...

Utilization review ensures medical care is used correctly and efficiently. Nurses often perform utilization reviews and coordinate with health plans. You can appeal a decision if your health plan ...

The utilization review process is designed to help hospitals determine the appropriate level of care and care setting for patients based on medical necessity. While this process is an expense for ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...