Utilization Review Process Paper

Decent Essays
Show More
The methods of evidence-based practice used in utilization review are based on clinical

guidelines, evidence based medicine, peer reviewed literature and methods, and are credentialed

programs (Aetna, 2010, p. 1). There are several guidelines used in the utilization review process.

These guidelines are listed under what is called “The Hub” where service oriented desktops are

stored within the company’s intranet. These desktops are our policies and procedures used in the

utilization review process.

Utilization review helps protect the customer from getting redundant procedures that could

impair their health and to assure the best health possible for the customer. The goal is to ensure

the member gets the care they

Related Documents

  • Improved Essays

    Pediatric Dosing Case Study
    • 1228 Words
    • 5 Pages

    Pediatric Dosing Case Study

    Layla Micheli Monica Malt LVN 121 11/17/2017 What were the Contributing Factors to the problems in this Case? Describe them by category below. Equipment (design, availability and maintenance) The Pyxis machine is designed to calculate patient medications and doses accurately and should have alerted the nurse when the dosage was too high for a pediatric patient.…

    • 1228 Words
    • 5 Pages
    Improved Essays
    Read More
  • Improved Essays

    Preventative Services Task Force (USPSTF) Guidelines
    • 641 Words
    • 3 Pages

    Preventative Services Task Force (USPSTF) Guidelines

    Everybody: Present guideline(s) that you found and appraise it or them using AGREE The U.S. Preventative Services Task Force (USPSTF) guidelines was chosen and appraised by utilizing the AGREE II instrument regarding the use of aspirin in the prevention or reduction of cancer. A drafted recommendation statement was presented in October 2015, which was released by the U.S. Preventative Services Task Force based upon a systematic review conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), this initial draft recommendation was submitted and opened to the public so that they could maintain "high level of transparency" in their development methods( USPSTF, 2015). According to Brouwers et al.…

    • 641 Words
    • 3 Pages
    Improved Essays
    Read More
  • Improved Essays

    Jairon's Case Summary
    • 2085 Words
    • 9 Pages

    Jairon's Case Summary

    JAIRON 04/16/2018 – 2 (7:00-9:00) – LUNES P: To continue to build a rapport with the client, and educate the family about personal hygiene. QMHP met with the client at his home. IIHC initiated a conversation about hygiene. QMHP noticed previously that Jairon as well as other family members appear to be unaware about the relevance of personal hygiene. This activity was created to help Jairon and his family to develop healthy hygiene habits, and contribute to the family dynamic.…

    • 2085 Words
    • 9 Pages
    Improved Essays
    Read More
  • Improved Essays

    Evidence-Based Evaluation/Screening Tool
    • 504 Words
    • 3 Pages

    Evidence-Based Evaluation/Screening Tool

    Identify the evidence-based evaluation/screening tool, the specifications for its utilization, and your chosen condition and population. What is the research-based evidence for this item? Being that I work in as an oncology I have seen first hand effects that cancer diagnosis and treatment can impact a patients emotions and well-being. I have seen patients show signs of major depressive disorder (MDD) as a result. I also found that some of these patients who suffer from depression might not be properly screened for signs of distress.…

    • 504 Words
    • 3 Pages
    Improved Essays
    Read More
  • Decent Essays

    The CPT Guidelines, Moodifiers, And Add-On Codes
    • 277 Words
    • 2 Pages

    The CPT Guidelines, Moodifiers, And Add-On Codes

    Discuss the CPT guidelines, modifiers, and add-on codes. s Current Procedure Terminology (CPT) is the nomenclature used to report procedures and services performed by physicians. The guidelines in the CPT manual are presented at the beginning of each section and are used to appropriately report and interrupt the services and procedures that are found in that particular section. They are important as they give specific instructions for that section such as dealing with unlisted services or procedures, special reports and supplies and materials provided for a particular service.…

    • 277 Words
    • 2 Pages
    Decent Essays
    Read More
  • Improved Essays

    Quality Improvement Project Paper
    • 883 Words
    • 4 Pages

    Quality Improvement Project Paper

    Surgical Site Infections are related to delayed healing, increased patient morbidity and mortality, increased hospital stay, readmission and facility costs. Anderson et al. (2014) explains that these infections extend a patients hospital stay on average of 7 to 11 days and cost roughly $3.5 to $10 billion annually in healthcare expenditures according to the consumer price index for inpatient hospital services. Most of these costs are not reimbursed by insurance because they fall within the 30-day readmission rate. Shepard et al.…

    • 883 Words
    • 4 Pages
    Improved Essays
    Read More
  • Improved Essays

    Utilization Management: The University Of Michigan Health System
    • 1221 Words
    • 5 Pages

    Utilization Management: The University Of Michigan Health System

    The University of Michigan Health System is one of the largest health care facilities in the world. The facility is also referred to as the University of Michigan Hospital. It is one of the largest hospitals in the state of Michigan, as well as a premier academic medical center. Michigan Health System has a vision of creating the future of health care through discovery, as well as to become the national leader in care, education, biomedical innovation, and health care reform (Regents, 2015). An important aspect of quality assurance is utilization management.…

    • 1221 Words
    • 5 Pages
    Improved Essays
    Read More
  • Improved Essays

    Client Assessment Paper
    • 559 Words
    • 3 Pages

    Client Assessment Paper

    I. Client Description From observation, the client is a young adult, Caucasian female. The client reported being a junior undergraduate student studying psychology. II. Presenting Concern(s) and Systemic Implications The client talked about having issues concerning lack of readiness for life after graduation.…

    • 559 Words
    • 3 Pages
    Improved Essays
    Read More
  • Improved Essays

    Pros And Cons Of Drug Utilization
    • 405 Words
    • 2 Pages

    Pros And Cons Of Drug Utilization

    The Drug Utilization Review (DUR) is a component of the patient’s electronic health record that provides several benefits to clinicians related to medications. In many healthcare systems, DUR’s are embedded throughout the facilities IT infrastructure and many times may often provide a higher degree of patient safety related to medication delivery and administration without the clinician having to actively or consciously seek out these benefits. DUR’s are essential and are especially beneficial to patients who may seek out medical treatments from several providers, and can also be beneficial with patients whose present or past medical conditions require interactions from multiple disciples or specialists. As is often the case with many patients,…

    • 405 Words
    • 2 Pages
    Improved Essays
    Read More
  • Great Essays

    Importance Of Ebp In Nursing
    • 1561 Words
    • 7 Pages

    Importance Of Ebp In Nursing

    First, nursing has always used research findings to support data collection, to suggest interventions and evaluate the quality and growth of patient care. This method is called research utilization (Spector, 2008). In research utilization, the different results from the studies are conveniently selected for the application in nursing practice. For evidence based research, the nurses will select the best evidence from the research, the results are analysed, synthesized and then integrated into practice (Spector, 2008, p.…

    • 1561 Words
    • 7 Pages
    Great Essays
    Read More
  • Improved Essays

    AT & T Advertisement Analysis Essay
    • 1307 Words
    • 5 Pages

    AT & T Advertisement Analysis Essay

    When a phone company puts out an advertisement, their main goal is to promote a message to prevent such tragic events from occurring in society. There are many advertisements trying to grab the audience’s attention to make a difference. In this advertisement, AT&T, uses a real life situation to show the audience how risky it is to use your phone while driving. Since AT&T is a major phone seller, they take advantage of that to reduce the number of accidents in a majority of people to make sure that the products that they sell aren’t a major cause in deaths. I believe that this advertisement is very effective, because not only does it provide a message to the audience, but it may save many lives as well.…

    • 1307 Words
    • 5 Pages
    Improved Essays
    Read More
  • Improved Essays

    Presto Cleaner Case Study
    • 841 Words
    • 4 Pages

    Presto Cleaner Case Study

    Mr. Shelton is upset because of many reasons. Presto Cleaner failed both in the service and with the customer. For many years he has been a loyal customer of Presto Cleaner’s and he didn’t received the treatment he deserved. Even if he tried to contact the company several times, he didn’t received an answer nor a call.…

    • 841 Words
    • 4 Pages
    Improved Essays
    Read More
  • Superior Essays

    1.1 Describe The Importance Of Having A Developing Relationship To A Business Relationship Analysis
    • 1142 Words
    • 5 Pages

    1.1 Describe The Importance Of Having A Developing Relationship To A Business Relationship Analysis

    1.1 Describe the importance of developing relationships with customers Having a good rapport with your customers is extremely important for the success of any company. Having a solid relationship with your customers can help ensure that the business continues to progress and remain successful. A good way to develop a solid relationship with your customers is to reward loyalty, by simply sending a thank you note or a money off voucher can help to build and maintain brand loyalty, it also helps to introduce incentives such as a customer loyalty program as it will help to entice customers to return.…

    • 1142 Words
    • 5 Pages
    Superior Essays
    Read More
  • Improved Essays

    3.4 Explain The Costs And Benefits Of Customer Service Analysis
    • 937 Words
    • 4 Pages

    3.4 Explain The Costs And Benefits Of Customer Service Analysis

    Every company strives to achieve excellent customer service standards. A company that is known for delivering exceptional customer service will often find that this can increase interest in their company and products. By letting the customer know what you are willing to do for them and what service you will provide for them you can set an expectation, by setting this expectation you can then exceed this as company.…

    • 937 Words
    • 4 Pages
    Improved Essays
    Read More
  • Great Essays

    Windows 10 Case Study
    • 1479 Words
    • 6 Pages

    Windows 10 Case Study

    10. Once an application which is playing audio is minimized, then it might stop playing this audio all over sudden. 11. Downloading of music in the Music Preview app and the Xbox Music are broken. Microsoft is expected to solve this problem.…

    • 1479 Words
    • 6 Pages
    Great Essays
    Read More

Related Topics

Ready To Get Started?
Discover
Company
Follow
©2024 Cram.com
Privacy Policy |  About Ads |  Site Map |  Advertise  | 
  • Cookie Settings