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Retrospective drug utilization review refers to drug therapy review that after patients have got the medication. [10] The retrospective drug utilization review has a typical process. [12] This is a computer based review. Computer will show data which are in violation of the standard.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
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 ...
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 ).
The steps described are: engage stakeholder, describe the program, focus the evaluation design, gather credible evidence, justify conclusions, and ensure use and share lessons learned. [22] These steps can happen in a cycle framework to represent the continuing process of evaluation.
A common stomach bug is surging, according to new data from the US Centers for Disease Control and Prevention.. In the week of December 5, there were 91 outbreaks of norovirus reported, up from 69 ...
A former Allianz fund manager was spared prison time on Friday over his role in a meltdown of private investment funds sparked by the COVID-19 pandemic that caused an estimated $7 billion of ...
An independent medical review (IMR) is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. Peer review also is used in order to define the review of sentinel events in a hospital environment for quality ...