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1) What are the primary categories of utilization management (UM)? How does UM determine medical necessity through the use of evidence-based guidelines?2) What are the key differences between convent

* ** uses evidence based ********** as **** ** ************ clinical ******** *** determining **** *** ** ********* necessary ** **** as appropriate *** **** ******* *** ******* ** **** as ************* ** ******* care ** in this *** **** ********** an ******** ***** approach ** health **** ************ ********* ** *********** ** ***** **** ** well as ********* *********** Management ** the function dealing specifically with *** medical necessity ** care It ** ********* **** ****** *********** ****** ** oversight *** ** ********* **** ** **** in case ********** interventions Moreover *** ********** ** ** ************* ***** ** *** light ** the **** **** either **** ** ***************** ***** **** ** lower ******* ** **** ** **** ** ***** costs ********* ***** ** ************* in this regard **** ** ****** **** the ******** ******* the right **** ** *** ***** **** ***** it is important ** **** **** UM’s goal is *** ** **** ******** **** *** ******* ** ****** **** *********** **** ** delivered ******* ***** ** *************** **** *** yield ********* ***** **** ***** sometimes outweigh *** potential benefits ** health **** ********* 2015) Primarily ***** *** ***** categories of Utilization ********** **** are *********** concurrent and ************* *********** implies ****** place ****** care ** ******** ********** means ****** ***** ***** **** ** being provided and ************* ******* ****** ***** after **** has been ******** However technology *** **** it ****** *** *** ********** ** use *********** ********** *** ******* *** ******** **** ***** **** ** *** ***** ***** *** **** ********** programs ********* ****** *** ******** *** *** ** a **** **** ** ********** ****** **************** ** well ** have ******* ****** ******** ******* ** their ****** *** ******* *************** Such ******** *** *** categorized ** high **** ******** *** **** varying combinations ** health ** **** ** ****** *********** disease ********** programs ** *** ***** hand ****** ****** *** ******** **** a ****** diagnosis ****** problem Although **** ******** ***** **** comorbid conditions those ***** **** ******* is * specific ********* generally **** * ********** ******** set ** needs ** ******* management ******** *** ** serve * ****** ***** ** ******** that **** a ****** ******* disease (Chen ***** ******* ***** all ******* ********** ** * ********* ******** ** ******** **** ** ** also * ***************** ****** at ********* *** quality ***** **** cost ************* ** **** *** ******** **** chronic ******** ***** are several ******** that seem ** ******* **** a disease ********** model ** **** ********* ****** ******** ********** arthritis ********************** * ****** The **** ** *********** Management ** Case ********** ****** Retrieved January ** **** **** http://wwwcmsaorg/Individual/NewsEvents/HealthTechnologyArticles/tabid/649/DefaultaspxChen A ****** **** ********* in Coordinated **** ************ Retrieved ******* ** **** **** **************************************************************


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UM uses evidence based guidelines as well as standardized clinical pathways for determining what may be medically necessary as well as appropriate and thus improve the quality as well as effectiveness of patie.docx

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