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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 ...
The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination.
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.
The process involved can be cyclical because of its client-centered nature. [5] According to the American Association on Mental Retardation (1994) "Case Management (service coordination) is an ongoing process that consists of the assessment of wants and needs, planning, locating and securing supports and services, monitoring and follow-along ...
Social work case management is a process of linking clients to services that enhance their functional capacity, from assessment to comprehensive intervention for equitable client care. [11] According to NASW (1984) "Case management is a mechanism for ensuring a comprehensive program that will meet an individual's need for care by coordinating ...
Program process monitoring is an assessment of the process of a program or intervention. Process monitoring falls under the overall evaluation of a program. Program evaluation involves answering questions about a social program in a systematic way. Examples of social programs include school feeding programs, job training in a community and out ...
Local disability theatre group. Social work management is the management of organisations or enterprises in the social economy and non-profit sector, e.g., public service providers, charities, youth welfare offices, associations, etc. [1] Social work management has been traditionally pursued by social workers, social pedagogues, pedagogues, psychologists without additional management skills ...
The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing factors, enabling factors, and need.