Healthcare Management: An Introduction

In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care....

In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care....

In claims administration terminology, a claims investigation is correctly defined as the process of

In health plan terminology, demand management, as used by health plans, can best be described as

In large health plans, management functions such as provider recruiting, credentialing, contracting, provider service, and performance management for providers...