Finding meaning in medical necessity.
Managed care organizations have become partners in patient care through their representatives/liaisons---care managers. This article uses personal experiences and relevant literature to highlight the professional conflicts care managers face in the struggle to fulfill two main clinical functions: applying criteria to determine medical necessity and educating practitioners and patients about effective and efficient treatments. Many care managers struggle to maintain cordial relationships with colleagues, while determining which requests for treatment are necessary versus discretionary, and insuring treatment excellence.
Schwartz
Jeffrey
J
Managed Health Network, New York, NY 10005, USA. Jeffrey.Schwartzmhn.com
Weiner
Michael B
MB
D019090:Case Management / Q000941:ethics*; D016265:Conflict of Interest; D006801:Humans; D019458:Insurance Coverage; D008329:Managed Care Programs / Q000458:organization & administration*; D020380:Needs Assessment; D010344:Patient Advocacy; D010353:Patient Education as Topic; D011361:Professional Competence; D024382:Professional Role; D012947:Social Work / Q000941:ethics*; D014481:United States