Jul 29, 2025 · Utilization management (UM) in healthcare is a structured, data-driven process used by health plans, hospitals, and insurers to evaluate the necessity, appropriateness, and …

Jul 10, 2023 · Utilization Management (UM), initially referred to as Utilization Review (UR), remains a well-recognized component of a cost management approach in the health care …

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 …

Aug 28, 2025 · Utilization management (UM) is a broad label for various insurance company policies designed to optimize health care value, including consumer and provider costs.

Utilization management helps ensure that patients have the proper care and the required services without overusing resources. NCQA Utilization Management Accreditation helps guarantee …

Jan 9, 2020 · Utilization management (UM) is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities …

Since providers are incentivized to manage total cost of care and population health, health plans increasingly shift utilization oversight from centralized UM departments to points of care …

Oct 14, 2025 · Utilization management (UM) refers to a set of processes to evaluate the necessity, appropriateness, and efficiency of healthcare services. It involves reviewing patient …

May 13, 2025 · Utilization management (UM) is crucial for chief medical officers, involving removing care barriers and devising discharge solutions. UM aims to manage healthcare costs …

UM is the process health plans use to ensure patients receive the right care at the right time—while also keeping healthcare costs in check. It includes three key steps: prior …