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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. [1] [2] A discipline-specific process may be referenced accordingly (e.g., physician peer review, nursing peer review).
Mrs. Woodruff left nursing school when she married, but she supported nursing causes throughout her life. [1] Two of the school's nursing specialties, pediatrics and midwifery, were highly ranked in U.S. News & World Report's 2012 edition of "America's Best Graduate Schools." The school's pediatric nurse practitioner program made its first ...
Drug use/ utilization evaluation and medication utilization evaluations are the same as drug utilization review. [ 3 ] With the development of society and the economy, the costs of health care grows rapidly, and this becomes a burden on the worldwide health protection system. [ 4 ]
Private sector involvement in Medicare and Medicaid is not limited to MCOs; private doctors, hospitals, nursing homes provide medical care; reimbursement claims are processed by private intermediaries; and peer review organizations, utilization review committees and accreditation organizations like JCAHO are staffed by private medical personnel ...
EMR utilization has saved JKL Healthcare approximately $50,000 on office supplies and has significantly reduced the number of medical records staff. [ 2 ] The JKL Healthcare System was one of the first successful implementers of EMR using the Epic System, and they became a model site for other healthcare systems.