Utilization Management
What Does Utilization Management Mean?
Utilization management is the process of evaluating the efficiency and appropriateness of healthcare usage. It involves reviewing healthcare services to ensure that only necessary, appropriate, and efficient services are being utilized. This process helps health insurance companies prevent wasted expenditures on unnecessary treatments, services, or medications.
Insuranceopedia Explains Utilization Management
Utilization management involves reviewing both inpatient and outpatient services to ensure that all benefits provided by an insurer are used properly and optimally. One goal is to ensure that the benefits offered by a health insurance company effectively meet policyholders’ needs while remaining cost-effective for the insurer. If the utilization management process finds that this is not the case, the benefits may need to be redesigned.
