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Other examples of utilization reviews might include determining whether or not a patient should be transferred to a specialty trauma ICU at a regional center or getting insurance approval for an extended hospital stay that goes beyond the typical guidelines.
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Types of Utilization Management UM has three main types of reviews: prospective, concurrent, and retrospective.
Utilization Review (UR) is the evaluation of medical care services for the treatment provided to an injured worker.
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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.
Summary. Utilization review is a process designed to ensure that medical care is effective, efficient, and in line with evidence-based standards of care. Utilization review specialists are often nurses. They work for health insurance companies, hospitals, and various other medical providers.