Utilization Management Strategies to Improve Quality and Contain Costs

Course overview

The state of healthcare in the U.S. is poor when compared to other developed countries and the need to balance cost and quality has become apparent (The Commonwealth Fund, 2019). Utilization management helps ensure the most optimal care is being provided and waste of resources or services is reduced when possible. Clinicians in utilization management perform a variety of functions to help achieve a balance between quality and cost of care. Utilization reviews are one method to reveal areas where cost or quality can be improved and can serve as a basis for quality improvement initiatives in all healthcare settings. Thus, the importance of utilization management will continue to grow as regulatory bodies and healthcare professionals strive to improve the state of U.S. healthcare. The goal of this course is to educate nurses, case managers, and social workers in all settings about balancing cost and quality.