Utilization Management: what do they do?

[futuredream]

Can anyone tell what is UM's responsibilities? Is it same as case management?

Thank you very much

[NRSKarenRN, BSN, RN]

check out our case management nursing forum...chock full of info.

see:

utilization review vs case management (504779) - nursing for nurses

[proudnurseRN]

At our hospital their main responsibility is figuring out where a patient is going post-hospital. Sitting up the nursing home, rehab, if the pt is going home getting the supplies they need, making sure everything is done for nursing home placement (TB test and chest x-ray). Seems like an easy job, until you have that one patient the doc wants out of the hospital but no one else wants them because of a lack of insurance or psychiatric hx.

[classicdame, MSN, EdD]

their job is to make sure the resources are being utilized appropriately. Facilities interpret that differently. Some insurance companies hire utilization review nurses to be sure the resources (benefits) are being used appropriately (not over/under paying someone to be off work, etc)

[futuredream]

Thank you very much everyone!