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There are three types of utilization reviews: Prospective review: determines whether services or scheduled procedures are medically necessary before admission. Concurrent review: evaluates medical necessity decisions during hospitalization. Retrospective review: examines coverage after treatment.
How to Become a Utilization Review Physician. The qualifications for a utilization review physician include an active medical license and board certification. Some employers prefer doctors with experience in certain specialties, such as occupational medicine, neurology, pain medicine, or psychiatry.
Utilization review is conducted to determine the appropriateness of levels of treatment and of giving opinions as to the reasonableness of charges for diagnostic or treatment services of the licensees of certain licensing boards (e.g., Board of Medicine, Iowa Code Chapter 148; Board of Podiatry, Iowa Code Chapter 149;
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.
By contrast, utilization review is the process of examining and assessing the necessity, appropriateness, and cost-effectiveness of healthcare services before, during, and after they are dispensed to patients. Utilization review is an element of utilization management that looks into healthcare services.
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Resources for Utilization Review Nurses UM work is not direct patient care it is primarily conducted using a computer and a telephone. While UM nurses do manipulate a lot of data, the work is highly clinical.

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