What Is the Difference Between Utilization Management & Utilization Review?

Healthcare institutions generally implement process improvement procedures to reduce operating costs and better the quality of patient care. Utilization review and management procedures play an important role in medical process improvement activities.

Utilization management concerns the strategies and policies that healthcare organizations--such as hospitals, medical labs and clinics--put into place to improve operating activities and ensure that patients receive an excellent quality of care, according to Paramount Health Care, an institutional healthcare provider.

Utilization review consists of methodologies, tools and information technology systems that a healthcare institution uses to ensure that patients receive adequate treatments based on their conditions, according to the Washington State Department of Labor and Industries. In short, utilization reviews help eliminate medical treatment fraud.

Healthcare professionals usually distinguish utilization review from utilization management, yet both activities often interrelate. For example, a hospital's general operations manager may direct a department head or nurse-in-charge to review patient care procedures and ensure that patients receive proper care in the short and long terms.