Alternate Job Titles: Home Care Case Worker | Home Care Patient Services Case Coordinator
Manages cases regarding utilization review, discharge planning, and patient services coordination. Collaborates with insurers, managed care organizations, referral providers, patients, and families to assist developing case management guidelines. May require a bachelor's degree. Typically reports to a manager. Gains exposure to some of the complex tasks within the job function. Occasionally direct...
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About Utilization Review
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
Critics have argued if cost cutting by insurers is the focus of their use of UM criteria, it could lead to healthcare rationing by overzealous denial of care as well as retrospective denial of payment, delays in care, or unexpected financial risks to patients.
Source: Wikipedia (as of 07/18/2019). Read more from Wikipedia
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