Utilization Management (UM) definition

Utilization Management (UM) means a system for reviewing the appropriate and efficient allocation of health care services given or proposed to be given to a Member. [See, ▇▇▇▇ ▇▇▇▇, §59A-57-3].
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Utilization Management (UM) means programs that reduce or change prescription drug utilization either by electronic or manual intervention.
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Utilization Management (UM) means a strategy designed to ensure that health care expenditures are restricted to those that are needed and appropriate by reviewing inmate/patient’s medical records through the application of defined criteria and/or expert opinion. It assesses the efficiency of the health care process and the appropriateness of decision making related to the site of care, its frequency and its duration, through prospective, concurrent, and retrospective utilization reviews.
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Examples of Utilization Management (UM) in a sentence

  • Care management typically encompasses Utilization Management (UM), Disease Management (DM) and Case Management (CM).

  • Mental health records must be readily available for Countywide QAPI and Utilization Management (UM) activities and provide adequate medical and other clinical data required for QAPI-UM, and Department use.

  • The Contractor shall have a Utilization Management (UM) Program assuring that beneficiaries have appropriate access to SUD services; medical necessity has been established, the beneficiary is at the appropriate ASAM level of care, and that the interventions are appropriate for the diagnosis and level of care.

  • All TRICARE requirements regarding Utilization Management (UM) and Quality Management (QM) shall apply to the TRICARE Overseas Program (TOP) unless specifically changed, waived, or superseded by the provisions of this section; the TRICARE Policy Manual (TPM), Chapter 12; or the TRICARE contract for health care support services outside the 50 United States (U.S.) and the District of Columbia (hereinafter referred to as the “TOP contract”).

  • The Contractor shall implement a Utilization Management (UM) Program that meets the requirements set forth in this section and that is documented in a plan as defined in KRS 304.17A- 600.

  • Contractor shall develop, implement, and continuously update and improve, a Utilization Management (UM) program that ensures appropriate processes are used to review and approve the provision of Medically Necessary Covered Services.

  • Services funded by this interlocal agreement will be monitored through TTBH’s Quality Management (QM) and Utilization Management (UM) programs.

  • Within units specified for mechanical harvesting the Contractor shall cut Included Timber using equipment with a boom having an operating radius of at least _25_ feet for bunching trees, capable of severing, lowering and placing trees up to _24 inches diameter at ▇▇▇▇▇ height on the ground prior to skidding.

  • DVA/VHA medical facilities shall be subject to the same Utilization Management (UM) and Quality Assurance (QA) requirements applicable to other network providers.

  • Utilization Management (UM) - The process of evaluating the necessity, appropriateness and efficiency of health care services against established guidelines and criteria.

Related to Utilization Management (UM)

  • Utilization management section means “you or your authorized representative.” Your representative will also receive all notices and benefit determinations.

  • Stormwater management BMP means an excavation or embankment and related areas designed to retain stormwater runoff. A stormwater management BMP may either be normally dry (that is, a detention basin or infiltration system), retain water in a permanent pool (a retention basin), or be planted mainly with wetland vegetation (most constructed stormwater wetlands).

  • Construction management means a project delivery method

  • Virginia Stormwater Management Program or “VSMP” means a program approved by the State Board after September 13, 2011, that has been established by a locality to manage the quality and quantity of runoff resulting from land-disturbing activities and shall include such items as local ordinances, rules, permit requirements, annual standards and specifications, policies and guidelines, technical materials, and requirements for plan review, inspection, enforcement, where authorized in this article, and evaluation consistent with the requirements of this article and associated regulations.

  • Construction management at-risk means a project delivery method in which the District awards separate contracts, one for architectural and engineering services to design an infrastructure facility and the second to a construction manager at-risk for both construction of the infrastructure facility according to the design and construction management services.