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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 ...
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 ...
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 review [ edit ] 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 nurse manager is the nurse with management responsibilities of a nursing unit. They typically report to a service director. They have primary responsibilities for staffing, budgeting, and day-to-day operations of the unit, bed site teaching, complaint investigations & conducting educational programs at unit base.
In the modern world, there are a number of nursing specialities. Professional organizations or certifying boards issue voluntary certification in many of these specialties. Advanced practice nursing
Primary nursing is a system of nursing care delivery that emphasizes continuity of care and responsibility acceptance by having one registered nurse (RN), often teamed with a licensed practical nurse (LPN) and/or nursing assistant (NA), who together provide complete care for a group of patients throughout their stay in a hospital unit or department. [1]
A director of nursing (DON) is a registered nurse who supervises the care of all the patients at a health care facility. [1] The director of nursing has special training beyond the training of a staff nurse for the position that pertains to health care management, and in some places, a director of nursing must hold a special license in order to be employed in that capacity.