Utilization Management

Utilization Management is a process used by healthcare providers and insurers to ensure that patients receive appropriate and necessary medical services while avoiding unnecessary procedures or costs. It involves reviewing medical care plans, assessing the necessity of treatments or tests, and ensuring that resources are used efficiently. The goal is to promote high-quality care, manage costs, and improve patient outcomes by making informed decisions based on evidence and guidelines. Ultimately, it helps balance the need for care with the need to use healthcare resources wisely.