Utilization Management

Utilization Management vs. Utilization Review... What’s the difference?

A.I.M.M. does not believe in the value of "Utilization Review", which is what is typically provided in the industry. We subscribe to the principles of “Utilization Management”, which is quite a different methodology, despite the similarity in names. Please indulge an over-simplified explanation of key differences. Unfortunately, most providers in the industry subscribe to diagnosis=length of stay=referral to medical management/case management/disease management. This is what we define as “Utilization Review”. We believe that Utilization Review can be performed by an intelligent piece of software (and have seen as much demonstrated by some of our competitors). However, in Utilization Management diagnosis=treatment plan=anticipated length of stay=discharge plan. If any of the components does not meet Optimum Recovery Guidelines and/or Best Practices Medicine, then the case is referred for individualized attention. This type of Utilization Management cannot currently be performed without human interaction in the form of professional Registered Nurse assessment.

"Pre-cert Plus"
Includes Inpatient and Outpatient Pre-Admission Review, Admission Review, Concurrent Review and Readmission Review. A toll-free number is provided for pre-certification. Pre-certification of any and all admissions and/or procedures as required per the Plan Document.

Maternity Management
Professional Registered Nurse conducted Pregnancy Risk Assessment, specialized education, and support throughout pregnancy and the post-partum period. This program also assists in identifying high-risk maternities for referral to Care Management.

Nurse on Call
Provides telephonic access to Registered Nurses to ask health-related questions (operational Monday through Friday, 9:00 a.m. – 5:00 p.m. EST, except holidays).