11 Utilization Management Case Management
Found 14 free book(s)
Managed Care 101: Utilization Management
www.apg.orgUtilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health ... care decision-making through case-by-case assessments of the appropriateness of care prior to its provision. Slide 11 More current and explicit descriptions of Utilization Management (UM)
THE HOSPITAL CASE MANAGEMENT ORIENTATION MANUAL
hcmarketplace.comshe provides hospital case management consulting services to ensure clients’ compliance with state and federal law and to ensure accurate reimbursement. As a consultant, she addresses hospital case management staff needs, such as education and orientation, competency testing, utilization management, readmission prevention, daily care coordination
3 Principles for Effective Social Work Case Management ...
www.bitfocus.comevaluation is the proper utilization of case management software. When you have a client management software that complies with industry data standards, facilitates streamlined intake and assessment, and allows for seamless generation of reports, you can rest assured that you are gathering the information necessary to best inform your practice.
RESOURCE GUIDE TO CASE MANAGEMENT
cdn-aem.optum.comJan 01, 2016 · 11. Does the UR process ensure the creation of an enduring and ... the need to work closely with case/utilization management and Physician Advisors, and the role they play in ensuring both hospital and physician regulatory compliance? 13. Is a regular analysis of the hospital’s Probe and Educate outcomes, PEPPER and other
Effective Case Management Models: Which Should You Use?
wwwfiles.ahcmedia.comintegration of utilization management into the case manager role vs. separate um / drg specialist role 25. advantages of each model integrated model ... 4/4/2014 9:00:11 am ...
Texas Resilience and Recovery
www.hhs.texas.govAug 31, 2004 · Providers must comply with the department's Utilization Management Guidelines, which are incorporated by reference, if contractually obligated to provide any mental health community services, including mental health rehabilitative, mental health case management, supported housing, supported employment, or Assertive Community Treatment (ACT).
Social Work Best Practice Healthcare Case Management …
www.sswlhc.orgThe result is the inconsistent application of Social Work in Healthcare Case Management. Case Management Social Work practice now varies from no involvement to task oriented discharge planning to complex patient care and family planning/intervention. Our patients and families receive varied degrees of benefit from Social Workers in Case Management.
Standards of Practice for Case Management - ABQAURP
www.abqaurp.orghe Standards of Practice for Case Management were first introduced by the CMSA in 1995 and then revised in 2002. we are pleased to offer the Standards of Practice for Case Management, 2010 revision, which provides voluntary practice guidelines for the case management industry. The Standards of Practice are intended to identify and address
Care Management Institute Guidelines
www.aamcn.orgof functions per setting, case-load is a range that is dependent on population served and the type of service delivery: payer side vs. provider side. Recommended Monthly Case-Loads for Specific Settings MCO/HMO 40 to 75 Inpatient (Hospitals) 35 to 40 Disease Management 75 to 100
Knowledge Management and Organizational Learning
www.uky.eduacquiring, and communicating knowledge and improving the re-utilization of knowledge. However, it is only in the last 15–20 years or so that a distinct field called “knowledge management” (KM) has emerged. KM is based on the premise that, just as human beings are unable to draw on the full
Texas Resilience and Recovery
www.hhs.texas.govsituation and prevent utilization of more intensive services. The desired outcome is resolution of the crisis and avoidance of intensive and restrictive intervention or relapse. These services do not require prior authorization. However, Utilization Management (UM) staff must authorize the crisis service within 2 business days of presentation.
Utilization Management as a Cost-Containment Strategy
www.cms.govUtilization management as a cost-containment strategy by Howard L. Bailit and Cary Sennett . Utilization management (UM) is now an integral part of most public and private health plans. Hospital review, until recently the primary focus of UM, is associated with a reduction in bed days and rate of hospital cost increases.
Guidelines for Grant Budgeting - The Global Fund to Fight ...
www.theglobalfund.orgDecember 2022. However, grant start and end dates shall be within the Allocation Utilization Period (see paragraph below). 17. Allocation Utilization Period. The Allocation Utilization Period is, usually, the three-year period6 during which the country allocation per disease component can be utilized to implement programs.
CLINICAL DOCUMENTATION MANUAL
cchealth.orgUtilization Review Manager, who is responsible for tracking any findings, following up on any quality issues, and identifying items for disallowance. BHSD Clinical Documentation Manual, Rev. …