Utilization Manager

Date of Publication:

4/9/2013

Definition:

Provides utilization management (UM) activities and functions by using military treatment facilities (MTF) specific quality improvement processes to identify areas for review from data, suspected problem areas, and input from departments or services within the facility. The utilization manager prioritizes accordingly based on high dollar, high volume or problem prone diagnoses. The utilization manager: Identifies gaps between desired and actual program outcomes and develops an action plan to fix gaps. Determines effectiveness of the plan and continually evaluates the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the right care, at the right time, in the right place, with the right provider, at the right cost. Collaborates with staff, facility departments, and outside agencies to determine the best, most cost-efficient care.