Critics of utilization review frequently are concerned that many of those persons participating in a...

Question

Critics of utilization review frequently are concerned that many of those persons participating in a utilization review are in fact practicing medicine. Although UR is conducted prospectively, it is used to authorize or refuse proposed treatments, referrals, and even hospital admissions.

Does UR constitute "practicing medicine" and if so should UR be limited to only those medical professionals licensed to practice medicine?
Discuss who you think should head the utilization review program and justify your answer.

I need 2-3 paragraphs, APA, 2-3 in-text citations, 2-3 references

tae_636610924705577856_117842_1.docx

Soumi · Accepted Answer

Running Head: UTILIZATION REVIEW		1
UTILIZATION REVIEW 		4
UTILIZATION REVIEW
Table of Contents
1. If Utilization Review constitutes practicing medicine and limited to only them	3
2. Suitable Head of the Utilization Review Program	3
References	4
1. If Utilization Review constitutes practicing medicine and limited to only them
	The Utilization Review (UR) is a program that is conducted in order to review the need of providing a recommended method of intervention. As stated by Goldberg (2016), a health insurance company reviews the requests it received for availing medical services, facilities and treatments with the help of UR. However, as this decision is a very grave one, involving determining if the provided coverage for the medical facilities is a suitable one or not, which in turn,

Critics of utilization review frequently are concerned that many of those persons participating in a utilization review are in fact practicing medicine. Although UR is conducted prospectively, it is...

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