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Utilization Review Archive

Concurrent Utilization Review – When is it Done?

The process of utilization review can start at any point along the continuum of needed services.  Utilization review coordinators who maintain an active healthcare license, i.e. registered nurses or licensed social workers, conduct utilization review in hospitals, or telephonically and on-site for managed care organizations. Concurrent utilization review takes place while...
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Do You Have What it Takes to be a UR Nurse?

Utilization reviewers working in hospitals, managed care organizations and other healthcare settings are usually registered nurses (RN) who have strong clinical backgrounds and excellent communication skills, along with substantial experience with medical criteria and guidelines (such as InterQual and Milliman).  UR nurses are tasked with "the evaluation of the medical...
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Understanding the Utilization Review Process

Utilization Review (UR) is a process implemented by hospitals, insurance companies, and other types of managed care plans. Included in the utilization review process, is the use of "explicit" criteria to determine the medical necessity of the treatment or the health care service appropriate for such a service. This is...
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