What is the difference between Case Mgmt and Utilization Review?Register Today!
- by MArdt1 Jul 17, '12Can anyone help me understand the difference?
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- Jul 17, '12 by dancingpreFrom my understanding, case management deals with the patients "case" and their path of treatment to try and make sure the keep within the hospitals goal LOS for patients. You deal a lot with the physicians, etc.
Utilization management is more of keeping track of supplies, etc, being used during treatment to keep the cost of having a patient within the goals of the hospital/facility.
As I said, that's my understanding but I could be wrong.
- Jul 17, '12 by MBARNBSNCase Management encompasses UM and Discharge Planning. Some Nurse Case Managers work only as Discharge Planners while others work only as UR Nurses. However, many of us work as both in order to maximize reimbursement rates from various payor sources. The results of Utilization Review helps to determine the appropriate level of treatment and the correct care setting for a patient. Based upon evidence based medical practice, a CM can make clinical decisions that assists with the discharge planning process.
- Aug 3, '12 by MintConditionfrom my understanding, cm is more dealing with the patient and UR is more dealing with supplies and payor source