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Utilization Management in Healthcare | Smartsheet
Jan 09, 2020Utilization management (UM) is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis process is run by — or on behalf of — purchasers of medical services (i.e., insurance providers) rather than by doctors.
Top Healthcare CQI Project Examples | Smartsheet
Jun 17, 2019Blue Cross Blue Shield of New Mexico performed a quality improvement project to improve how it processed complaints from its members about quality-of-care issues at health facilities. Other projects include the following: The Safer Care Patient-Centered Checklist: This was an intervention to promote safe, high-quality practice and improved outcomes. . This
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