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Utilization Manager

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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.

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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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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 ...

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