What is the main function of utilization management (UM) in healthcare?

The primary function of utilization management (UM) in healthcare is to identify, monitor, evaluate, and resolve issues related to the appropriateness and efficiency of healthcare services. UM involves assessing the necessity and level of care provided to ensure that patients receive appropriate services while also managing healthcare costs. This process includes reviewing medical necessity, treatment plans, and utilization patterns to avoid unnecessary tests or procedures that do not benefit the patient’s health outcomes.

By focusing on monitoring and evaluating healthcare services, UM helps organizations improve the quality of care and resource allocation. This comprehensive oversight is essential for maintaining patient safety and ensuring that healthcare providers adhere to established guidelines and standards of care.

In contrast, the other choices focus on narrower aspects of healthcare management. While managing staff requirements, facilitating admissions, and monitoring pharmaceutical prescriptions are important in their own right, they do not capture the overarching goal of UM, which is to optimize the patient care experience through detailed oversight of service utilization.