Utilization Review Made Easy (Part 2)

If you are a case manager or utilization review nurse, I can really empathize with how much pressure you face in your job to make fast decisions on a myriad of different medical issues and types of cases, without a lot of time for deliberation. Yet, in today's day and age it is even more important for you to be able to make effective decisions and know that you're using the latest knowledge and the latest standards of care in order to back up your determinations. If you are a managed care nurse or a utilization review specialist you can't afford to do this without the backing of a good IRO.

Why is this? The standard of care is too complex. The answers to medical necessity questions are constantly shifting. New technologies are coming online. New treatments are going from experimental/ investigational to standard. As a utilization review nurse you can't possibly be expected to be able to stay on top of all of these changes and shifting standards. Using an IRO and plugging into the specialist knowledge base is absolutely critical to the utilization review function today. That is why most Utilization Review companies and medical management firms have made this a best practice.