Debbie Hill, MSN, RN, is a master’s prepared registered nurse with over 30 years’ experience in healthcare. She is the Senior Director for Utilization Management and Appeals & Grievances Product Applications at Medecision. Her role as a clinical consultant to the platform engineering team includes research, product development, and application deployment for healthcare payers serving Medicare, Medicaid, and commercial lines of business.
Medical loss ratio (MLR) rebates hit a record $1.3 billion in 2019 because health plans spent too little on medical claims and too much on administrative costs. How can health plans leverage their utilization management programs to better balance their medical and administrative expenses?
Healthcare organizations’ success under risk sharing and value-based care relies on a well-oiled UM program.
Until recently, Utilization Management was all about how health plans determine preauthorization. But that definition is fast becoming outdated.
What does Utilization Management have to do with Population Health? The answer: everything.
