utilization management
Number of sources: 3
Paper instructions:
The principal objective of utilization management is the reduction of practice variations by establishing parameters for cost-effective use of health care resources. There are four main techniques or tools used in utilization management: demand management, utilization review, case management, and disease management. Utilization management helps MCOs control costs and improve quality.
Refer to the readings of this week and the Internet on the above information, answer the following questions:
What are the challenges faced by MCOs regarding practice variations? What do you think can be done to meet these challenges?
Differentiate between the three main processes of institutional utilization management.
Determine the main purposes of each process of institutional utilization management? Which process do you think is the most important, and why?
Research the role of the utilization management nurse.
Explain the functions of the utilization management nurse, and compare and contrast the information from that organization.
Explain your understanding of disease management and case management. What in your opinion are one major similarity and one major difference between the two types of management?
Now, access information on disease and case management by searching the Internet by using the following keywords:
Care Continuum Alliance
Commission of Case Manager Certification
Based on your research, answer the following questions:
What is the purpose or mission of these professional organizations?
What standards do these organizations set for certification or membership?
How do these organizations define disease or case management and do they differ from the text definitions?
To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Your initial posting should be addressed at 150-300 words. Submit your document to this Discussion Area by the due date assigned. Be sure to cite your sources using APA format.
Respond to your peers throughout the unit. Justify your answers with examples, research, and reasoning. Follow up posts need to be submitted by the end of the week.
Week 3 Project
Assignment
Task: Submit to complete this assignment
Due July 21 at 11:59 PM
Current Trends and Issues in Managed Care
Using the South University Online library or the Internet, research on a series of topics that will help you understand the current issues regarding managed care. You can use keywords, such as (but not limited to) managed care, current trends and issues in managed care, pharmacy benefit management, or utilization management. Like many other aspects of health care, managed care is continually changing and evolving to meet current consumer and market demands. This week, you are required to write an essay on the following topics:
Pharmacy benefit management
Utilization management
Use the following guidelines for developing your essay:
Select at least two articles for each topic from the SUO library, and write a review for each source of information.
Present a summary for each topic tying together the information learned about that topic.
Describe and evaluate the market forces, current trends, and changes in drug benefit programs over the last fifteen years.
Discuss basic approaches and techniques used in utilization management.
Analyze the future of utilization management approaches. How might they change and why?
Justify your ideas and responses by using appropriate examples and references from reputable and scholarly texts, websites, and other references.
As in all assignments, cite your sources in your work and provide references for the citations in APA format.
This is a 3–5-page paper completed in APA format that includes an introduction and conclusion.
Please refer to the rubric for this assignment for full understanding of the requirements.
