Defining the parameters of case management in a managed care setting.
The authors explore how case management evolved from utilization review in order to address the lack of flexibility of basic utilization review. They examine case management's widely diverse state regulatory oversight as well as its lack of a clear definition. The authors then suggest three mechanisms that might be used to devise a universal definition of case management. For the purposes of this article, the authors use the term case management in connection with health benefits plans.
URAC/American Accreditation Healthcare Commission, Washington, D.C., USA.
G
G
Carneal
G
G
D'Andrea
D000068:Accreditation; D019090:Case Management / Q000331:legislation & jurisprudence / Q000592:standards; D008329:Managed Care Programs / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000706:statistics & numerical data; D013219:State Government; D014481:United States; D014600:Utilization Review