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2. URAC - Wikipedia

   en.wikipedia.org/wiki/URAC

   URAC's accreditation programs include specialty pharmacy, digital health, utilization management, health plan, case management, and others. [4] In order to earn an accreditation, organizations submit various policies and procedures which are reviewed by a nurse or pharmacist and then the Accreditation Committee. [5] Accreditation lasts for ...

3. Utilization management - Wikipedia

   en.wikipedia.org/wiki/Utilization_management

   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 ...

4. Managed care - Wikipedia

   en.wikipedia.org/wiki/Managed_care

   Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.

5. Texas Health and Human Services Commission - Wikipedia

   en.wikipedia.org/wiki/Texas_Health_and_Human...

   The Texas Health and Human Services Commission (HHSC) is an agency within the Texas Health and Human Services System. It was established by House Bill 2292 in 2003 during the 78th Legislature, [ 1 ] which consolidated twelve different healthcare agencies into five entities under the oversight of HHSC.

6. Registered nurse - Wikipedia

   en.wikipedia.org/wiki/Registered_nurse

   A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to obtain a nursing license.

7. Clinical peer review - Wikipedia

   en.wikipedia.org/wiki/Clinical_peer_review

   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 ).