Clinical Solutions


Utilization Management, Plan, and the Utilization Review Committee

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A Utilization Management (UM) Program is necessary to establish activities to ensure appropriate access to services and levels of care. Organizations must continuously evaluate the medical necessity, appropriateness, and the efficiency of the use of healthcare services, procedures, and facilities under the provisions of the applicable health benefits plan. This evaluation process is called Utilization Review (UR) and is a required Condition of Participation (CoP) all Acute Care Hospitals and Critical Access Hospitals need to have in place.

Join QHR Health for this one-hour discussion to learn more about the required CoP components of the UM process, status management, financial implications, and UM Plan and UR Committee functions.

Contact hour

Learning Outcomes:

  • Identify the foundational component needed for an effective UM Program
  • Communicate the most important component a Utilization Review Committee must have in place to carry out the UR functions

Who Should Attend:

  • CFOs
  • CNOs
  • Care Management Leaders
  • Nursing Leaders
  • UM Physicians


QHR Health Learning Institute is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Participants who attend 100% of the program and respond to all of the interactive questions during the program related to the content will earn one (1) contact hour (note: contact hours will not be provided to those who listen to the recording).

The speaker and none of the planners for this activity have relevant financial relationship(s) with ineligible companies to disclose.