Utilization Management

Utilization Management (UM) is a critical process in healthcare administration that involves evaluating the appropriateness and medical necessity of health care services, procedures, and facilities according to evidence-based criteria or guidelines. Coursera's Utilization Management catalogue teaches you the fundamental principles of managed care techniques, including prior authorization, case-by-case assessments, and the use of evidence-based criteria to guide decision-making in healthcare delivery. You'll learn to analyze medical appropriateness, implement UM policies and processes, apply UM criteria frameworks, and conduct prospective, concurrent, and retrospective reviews for cost-effective healthcare management. Mastering Utilization Management empowers healthcare professionals to optimize resource allocation, improve patient outcomes, and navigate the complex landscape of healthcare cost management, making it an essential skill for those working in insurance, healthcare administration, and clinical settings.