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Utilization management. 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 appropriateness before it is provided using evidence-based criteria or guidelines.
The Risk and Insurance Management Society, Inc. ( RIMS) is a professional association dedicated to advancing the practice of risk management. [1] [2] It was founded in 1950, and is headquartered in Manhattan, New York City, United States. It publishes the industry-focused Risk Management magazine. RIMS represents more than 3,500 industrial ...
Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to protect against the risk of a contingent or uncertain loss. An entity which provides insurance is known as an ...
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving American ...
LOMA, (formerly the Life Office Management Association) working together with LIMRA (formerly Life Insurance Marketing and Research Association) under the umbrella organization LL Global is an American trade associations for the insurance industry in the United States.
Pharmacy benefit management. In the United States, a pharmacy benefit manager ( PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. [ 1][ 2] PBMs operate inside of ...
Risk management. Risk management is the identification, evaluation, and prioritization of risks followed by coordinated and economical application of resources to minimize, monitor, and control the probability or impact of unfortunate events or to maximize the realization of opportunities. [ 1]
These new insurance contracts allowed insurance to be separated from investment, a separation of roles that first proved useful in marine insurance. The first printed book on insurance was the legal treatise On Insurance and Merchants' Bets by Pedro de Santarém (Santerna), written in 1488 and published in 1552. [36] [37]