Health care providers and other interested parties must continuously look for ways to manage limited resources while improving quality and promoting patient safety. Utilization management is intended to “make sure that health care is delivered in the most efficient and effective manner for the patient and the population, where such activities directly impact the quality of outcomes” (Pelberg in Varkey, p. 145). The utilization management process bridges clinical, financial, and administrative functions.
Within traditional health care settings, utilization management can have a significant impact on the delivery of services. In addition, various models of care are emerging that may help transform health care delivery to achieve the aims of utilization management and quality improvement.
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