Utilization Management

Utilization Management
• What are the challenges faced by MCOs regarding practice variations? What do you think can be done to meet these challenges? • Differentiate between the three main processes of institutional utilization management. • Determine the main purposes of each process of institutional utilization management? Which process do you think is the most important, and why? • Research the role of the utilization management nurse. • Explain the functions of the utilization management nurse, and compare and contrast the information from that organization. • Explain your understanding of disease management and case management. What in your opinion are one major similarity and one major difference between the two types of management? Now, access information on disease and case management by searching the Internet by using the following keywords: • Care Continuum Alliance • Commission of Case Manager Certification Based on your research, answer the following questions: • What is the purpose or mission of these professional organizations? • What standards do these organizations set for certification or membership? • How do these organizations define disease or case management and do they differ from the text definitions?