Jul 10, 2023 · Utilization Management (UM), initially referred to as Utilization Review (UR), remains a well-recognized component of a cost management approach in the health care …

Jul 29, 2025 · Utilization management (UM) in healthcare is a structured, data-driven process used by health plans, hospitals, and insurers to evaluate the necessity, appropriateness, and …

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 …

Oct 14, 2025 · Utilization management (UM) refers to a set of processes to evaluate the necessity, appropriateness, and efficiency of healthcare services. It involves reviewing patient …

Jan 9, 2020 · Utilization management (UM) is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities …

Collection and use of relevant clinical information to make utilization management decisions. Qualified health professionals assess requests and make utilization management decisions.

Nov 6, 2025 · Utilization management is the strategic balancing act of modern healthcare—a framework built to align clinical quality with financial responsibility. It's a system of checks and …

Aug 28, 2025 · Utilization management (UM) is a broad label for various insurance company policies designed to optimize health care value, including consumer and provider costs.

This article delves into the key policy changes affecting utilization management (UM), with a focus on the future of UM, changes to the Affordable Care Act (ACA), and interoperability.

Oct 11, 2024 · Utilization management acts as a mechanism for identifying and prioritizing patient needs, ensuring that the right resources—whether it’s staff time, specialized equipment, or …