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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 cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual. [5]
After graduating from a school of nursing, one takes the NCLEX exam to receive a nursing license. A nursing license gives an individual the permission to practice nursing, granted by the state where they met the requirements. NCLEX examinations are developed and owned by the National Council of State Boards of Nursing, Inc. (NCSBN). The NCSBN ...
The criticism was two-fold: First, for the mishandling and poor communication of exam cancellations by both USMLE program administrators and the third-party exam administrator, Prometric. Second, the pandemic crisis exacerbated existing resentment towards the high-stakes nature of the exam: namely, several students and physicians were upset ...
A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. [1] [2] NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications and formulate treatment plans. NP training covers basic disease prevention, coordination of care ...
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The American Nurses Association recognized the Omaha System as a standardized terminology to support nursing practice in 1992. In 2014, Minnesota became the first state to recommend that point-of-care terminologies recognized by the American Nurses Association be used in all electronic health records. The evidence underlying this decision was a ...
The exam is a two-day computer-based examination consisting of up to 420 multiple choice questions, and up to 26 additional clinical decision-making cases. [6] The mean score for COMLEX-USA Level 3 is approximately 520 (for first-time test takers), with a standard deviation of about 85. [7] It covers the clinical disciplines of medicine, including: