Compare utilization review and utilization management

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Assignment: Using the information in the required readings as well as some additional research in peer reviewed sources, complete your Case Assignment by answering the following:

1. Compare and contrast utilization review and utilization management in health care. What are the similarities and the differences between each type of assessment? (Hint: One is generally a prospective process, and the other is generally a retrospective process).

2. Explain the specific role of each method in providing value-based health care. Who benefits from the method-the health care system, the insurance company, and/or the patient?

3. Articulate how individual case management is critical to a hospital's long-term survival. In what way does this practice protect your patients while keeping your doors open for business?

4. What are the ethical pitfalls to be aware of in performing these types of quality reviews? What must health care managers be aware of in terms of ethical pitfalls and also potential unintended negative consequences?

Reference no: EM132531434

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