Utilization and Case Management

 

What is utilization and case management?
How is this related to managed care and quality care and control issues?
How does APNP clinical expertise and patient management skills provide a foundation for utilization and case management?
Provide an example of how case management improves patient care outcomes.
Use an EBP research article to support your case.
Provide detailed examples.

 

Sample Solution

Utilization and Case Management

Utilization management is a complex process that works to improve healthcare quality, reduce costs, and improves the overall health of the population. It is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis. This process is run by, or on behalf of, purchasers of medical services (i.e., insurance providers) rather than by doctors. Hospitals, medical staff, insurers, and patients are all affected by utilization management. The advanced practice nurse prescriber (APNP) designates the unique population of the patients. The APNP has unique attributes of complex skills of decision making. They also have clinical competence and expert knowledge which form a great foundation for case management and utilization.

 

 

Vanity Fair

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