Who Performs Utilization Management?

At least two of the committee members must also be doctors of medicine or osteopathy. Hospitals are increasingly turning to physician advisors to fill this role and spearhead utilization management programs. Physician advisors are providers with specific experience in reimbursement and health policies.

Who Performs utilization review?

Utilization review nurses perform frequent case reviews, check medical records, speak with patients and care providers regarding treatment, and respond to the plan of care. They also make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

Who is ultimately responsible for a hospital utilization management function?

Utilization Review Committee – The chief medical officer or chief of staff as specified in the medical staff bylaws is responsible for appointing at least two physicians, one of whom acts as chair, to handle utilization review functions.