Managed Care Organization Plans

Customer Inserts His /Her NameCustomer Inserts Grade CourseCustomer Inserts Tutor s NameAugust 10th , 20081 . Discuss physical exercise Management . Define it and question its purpose discuss its components and regalees discuss who is snarly in the each step of the processes discuss the types of amount used discuss how it is used for entrys and discharges and describe the differences between nifty c atomic number 18 work instruction and chronic c atomic number 18 utilization management . You may organize this section in whatever way you see fit . Proper sectional headings are requiredDefinition of Utilization ManagementUtilization management is evaluating the suitability of checkup need and energy of HYPERLINK hypertext transfer protocol /en .wikipedia .org /wiki /Health_ address o Health care health care services procedures and facilities . These have to match the requirements of the appropriate HYPERLINK hypertext transfer protocol /en .wikipedia .org /wiki /Health_benefits o Health benefits health benefits plan . It describes procedures that are practical and these procedures accommodates the grooming involved in front the discharge and some opposite planning such as concurrent planning , pre-certification and clinical case appeals . Besides theses , there are many other processes that utilization management covers . These include concurrent clinical and HYPERLINK http /en .wikipedia .org /wiki /Peer_review o Peer review peer reviews and the requests of the provider , payer or patient are also jamn into considerationPurpose of Utilization ManagementThe basic purpose of utilization management is to take care and manage the health care cases not and efficiently but cost effectively as hygienic both before and during the health care administration . both the aspects of managing utilization management are important and if taken care of tin bring great success that is beneficial for the patients as well as the physicianComponents and ProcessesThere are several kinds of processes are involved in utilization management . They include pre-certification review , admission review continued stay review and discharge planning ( HYPERLINK http /www .amazon .

com /exec /obidos /search-handle-url 5Fencoding UTF8 se arch-type ss index books field-author Garry 20Carneal Carneal ,2000Pre-certification ReviewFor this , a medical certificate is required before a patient merchant ship be admitted to an acute care facility or before the patient has to be given the medical services . This process assures that consideration should also be given to all the non-emergency manipulations and not just the emergency cases . This determines the suitability of the facilities that are suggested and whether treatment would be suitable on an inpatient or outpatient basisBefore the patient can formally be admitted to the acute care facility , the patient has to provide his basic diagnostic information to the utilization management personnel . This process is basically for the non-emergency cases and is also known as elective admissions . An elective admission is a planned treatment . This can also be delayed for a occurrence time period without risk of everlasting disability . These include vasectomies , hernia repairs , hysterectomy , etcAfter a patient has been enrolled , the utilization management coordinator so compares that individual s request for an elective . The cases that have to be dealt desperately occur the same...If you want to get a full essay, ensnare it on our website: Orderessay

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