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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 ...
As initially passed, the ACA was designed to provide universal health care in the U.S.: those with employer-sponsored health insurance would keep their plans, those with middle-income and lacking employer-sponsored health insurance could purchase subsidized insurance via newly established health insurance marketplaces, and those with low-income would be covered by the expansion of Medicaid.
The Affordable Care Act (ACA) established the health insurance rate review program in order to protect consumers from unreasonable rate increases. [1] Through this program, proposed premium increases in the small group and individual markets that are above a threshold amount (ten percent or more, as of February 2014) are reviewed by states or the federal government to determine whether the ...
New Jersey's historic Crocker Mansion in Mahwah was officially put back on the market this month after it was seized from a billionaire fraudster in 2023. The 120-year-old estate at 675 Ramapo ...
Seventy-five-year-old Marina Terishvili's teenage son Mamuka was shot dead at a nationalist rally in Georgia in 1992. Now her other son, Giorgi, has been arrested for his role in protests against ...
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 ...
"I sat there every day (of filming) in complete awe of what they do, you know, watching people create, love, connect, share, build, grow. It was just wild," Brent recalls.
Their data has impact: a nurses' union's 2011 public statements cited Becker's data to justify their demands. [7] Becker's reports on how data is used (or abused) [8] and they cite, review and analyze [9] surveys and rankings, [10] including how various subgroups of medical practitioners are affected. [11]