Discussion:
Q: How does the government determine if over utilization or improper utilization is taking place by a provider?
Utilization management is essential to managed care organizations in order to reduce practice variations and control the use of healthcare resources. Utilization review (UR) nurses are often used to monitor care and determine whether or not specific treatments are appropriate. UR nurses must consider the needs of the patient while also ensuring that providers are administering care in a cost-effective manner.