What Is the Difference Between Utilization Management & Utilization Review?

by Marquis Codjia - Updated September 26, 2017
Utilization management reduces healthcare costs.

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

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

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.

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Correlation

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.

About the Author

Marquis Codjia is a New York-based freelance writer, investor and banker. He has authored articles since 2000, covering topics such as politics, technology and business. A certified public accountant and certified financial manager, Codjia received a Master of Business Administration from Rutgers University, majoring in investment analysis and financial management.

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