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Utilization Management Assignment Overview Please view the following video: Utilization Review Committee - Resource Management Operations: https://www.youtube.com/watch?v=6vpUB6HCnrM The value of...

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Utilization Management

Assignment Overview

Please view the following video:

Utilization Review Committee - Resource Management Operations:
https://www.youtube.com/watch?v=6vpUB6HCnrM

The value of utilization management and review has been debated among the leaders in health care since its inception. For this module's case assignment, you are going to engage in the review of a utilization management plan for a health care organization.

Assignment Expectations

Search the Internet for a hospital or other health care organization's utilization management plan. Once you have found one, prepare a 4- to 6-page paper. (This does not include the title or reference page) in which you address the following:

  • Identify the organization you researched and include the URL for the page of the utilization management plan that you examined.
  • Provide an overview of the organizations utilization management plan- specifically, discuss each of the elements of the plan and describe how each of the elements contributes to health care quality.
  • Identify two weaknesses of the organizations utilization management plan and describe "why" you consider them to be weaknesses. Postulate ways in which the weaknesses can be overcome.

I need 5-6 pages, APA, 4-5 in-text citations, 4-5 references

Answered Same Day May 05, 2020

Solution

Akansha answered on May 07 2020
133 Votes
Running head: Utilization Management
Utilization Management
Student Name
University Name
Date
Contents
Tenet Healthcare Corporation    2
Overview of the organizations utilization management plan    2
Two weaknesses of the organizations utilization management plan    7
References    8
Tenet Healthcare Corporation
https:
www.tenethealth.com/docs/default-source/medically-necessary/policy---comp-rcc_4-52_utilization_management_plan.pdf?sfvrsn=30082db7_2
Tenet Healthcare is a multinational healthcare services provider organization located in Dallas, Texas. In 2016 including its subsidiaries,
ands, partnerships, and joint ventures, Tenet has nine health departments in the UK and 470 outpatient centers in the US. Also in the US, Tenet operates total 20 "short-term stay" surgery hospitals and seventy-nine general emergency hospitals in 14 states, mainly in Florida, Texas, Michigan, and California (Tenet Healthcare Corporation, 2014).
Overview of the organizations utilization management plan
Utilization Management plan refers to a hospital-wide plan that includes the basic needs for establishing and for implementing a UM plan to make sure the quality, efficiency and suitability of resources and care provided by Tenet hospitals and medical personnel.
I. Purpose (scope): Tenet Healthcare and its affiliates and subsidiaries; any other entities or organizations in which Healthcare Corporation and its affiliates own 50% or more of direct or indirect equity; and any hospitals or medical institutions whose members manage or control the day-to-day operation of the facility.
II. Goals and objectives: Determine the content of the complete utilization management map, which is required to meet the participation of medical conditions, medical assistance program requirements and the use of all payers’ management requirements.
III. Authority & responsibility for the implementation: Tenet Hospital Management Committee. Provide the manpower, information, and physical resources that the department needs to perform its functions under the UM program. Bay commissioned UM medical staff, UM committee and CEO to implement the UM plan. Requests hospitals and medical personnel to perform and report usage management activities throughout the organization.
A. Main board of directors: They work as a subcommittee of medical executives committee and also work as a subcommittee for the improvement of medical performances (Liu, 2014).
B. Senior leadership: The medical staff and CEO leader at Tenet are liable for ensuring that everyone complies with the needs of this plan or policy. CEOs and health staff leaders should instantly report compliance violations to the Compliance Officer.
C. Medical staff & hospital departments: Utilization management Committee is a standing committee for medical personnel at the Tenet and must consist of more than two physicians and practitioners to execute the utilization management plan functions.
D. Professional RC: The medical necessity to review professional services will be completed by the appropriate Peer Review Committee based on the medical staff's charter.
1) Committee structure: Two members of review committee should be medical or osteopathic doctors, and at...
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