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Utilization Manager

For this assignment you are to interview a utilization manager, disease manager, or case manager at a local hospital or home health agency. Use your textbook (essentials managed health care) as a guide to develop a set of questions regarding the role of the person you are interviewing and investigate how he/she perceives the impact of his/her role on cost management and quality of patient care. Also, determine the relationship between this role and that of the health care administrator.

Solution Preview

Step 1
Interview with utilization manager
Q. What is your role at our local hospital?
UM. I am responsible for high quality, medical outcomes for patients who are enrolled with us. I must also ensure that the treatment is cost efficient.
Q. What are your responsibilities?
UM: I must screen those persons who are enrolled for case management and disease management.

Step 2
Q. What is the impact of your role on cost management?
UM: The effect of my position on cost management is substantial. I review precertification requests for medical necessity. Those who require additional specialization are referred to the Healthcare Administrator. I also review clinical information for concurrent reviews and ...

Solution Summary

This solution explains the role of the utilization manager in managed healthcare services. The sources used are also included in the solution.

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