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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 ...
Advanced certification is available to Hospital Case Managers through the Accredited Case Manager (ACM) Certification, offered by ACMA. The ACM Certification is the only certification that is specifically designed to validate an individual's competency in hospital case management practice, and is offered to both Nurse and Social Work Case Managers.
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 American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), is a certification body for nursing board certification and the largest certification body for advanced practice registered nurses in the United States, [1] as of 2011 certifying over 75,000 APRNs, including nurse practitioners and clinical nurse specialists.
Their goal is for every physician in their organization to adapt the EMR at a 100% utilization rate in order to increase efficiency and reduce adverse patient outcomes. 450 physicians were required to attend a 16-hour training session in order to obtain a certification that would allow them to admit patients. 1,700 Non-physician employees were ...
In some programs an active LPN license can replace the first two years of nursing classes. Advocates for ADN and diploma programs claim that such programs take an on-the-job training approach, and that the BSN should remain an academic degree that emphasizes research and nursing theory. Some states require a specific amount of clinical ...
This task force considered that drug utilization review was potential but this review should be evaluated and need valid evidence to put into effect. [7] In 1970, Drug utilization review program was carried out by a private pharmaceutical management company. It focused on the cost of another program. [7]
As an example, if the Utilization review nurse had negligently applied the discharge protocol for hemorrhoidectomy rather than Total Abdominal Hysterectomy, and if Calad had died from complications resulting from the treatment decision to treat her on an outpatient basis with discharge instructions after only 1 day of hospitalization, the case ...