Utilization review and management is the black sheep of the revenue cycle. A set of clinical functions within a billing process, UR and UM are often mysterious and underutilized. When designed and resourced properly, UR and UM can save hospitals significant revenue.

This guidebook provides healthcare systems with actionable steps to implement Utilization Review and Utilization Management processes. This comprehensive resource guides leaders through best practices, implementation options, and regulatory requirements. Understand the history of Utilization Review, the difference between UR and UM, and how to build sustainable processes that suit your healthcare organization.

Written by Dr. Tabitha Hapeman, an industry expert and thought leader in Utilization Review and Case Management, this book will provide you the tools and information you need to build the best UR and UM processes, department, and committee for your organization.

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