What does UM mean in MANAGEMENT

Utilization Management involves a specified process for review, authorization/preapproval, and organized management of health care delivery.

UM helps ensure that medically necessary services are appropriate, cost-effective, and meet the medical needs of patients. Having a well-managed utilization can improve patient care by increasing operational efficiency, reducing costs associated with unnecessary treatments or tests, and optimizing resource use.

Generally, the insurer or managed care organization is responsible for managing utilization. This can include medical directors who review claims or an interdisciplinary team who reviews case by case. Depending on the size and structure of the organization, multiple departments may be involved in overseeing utilization.

Insurers benefit from using UM because there are potential savings gained from requiring preauthorization for certain services as well as improved quality of care from ensuring appropriate treatment based on individual patient needs. Other benefits include better tracking of costs associated with individuals receiving treatments or procedures and allowing for more proactive risk management strategies.

Providers face challenges related to dealing with stringent guidelines set by payers and having restricted access to certain services due to prior authorization requirements imposed by insurance companies. Furthermore providers must also be mindful of shortened time frames within which they are expected to complete their paperwork investigations into the necessity of requested treatments or services.