Benefits of Certification

Organizations that provide delegated or other support services for URAC-accredited Health Utilization Management organizations

First, URAC’s HUM Certification demonstrates your proven commitment to high performance by embedding quality management principles into your daily operations. The certification process verifies you have reviewed and confirmed your operational soundness, developed policies and procedures, set priorities and identified organizational improvements.

Second, URAC Certification means your HUM-accredited partners do not have to conduct delegation oversight; they will use your certification instead. This makes your organization an easy choice when they are selecting a service provider or delegated entity.

What to Expect

URAC collaborates with your team to assess your HUM approach and create a flexible framework for continuous improvement. While our experts define the standards of excellence in utilization management, they do not prescribe how your practice should meet those standards.

In addition to health care management standards (ethics, information systems, quality management and regulatory compliance) and certification-specific standards, all HUM Certifications include the following Foundational Focus Areas:

  • Risk Management
  • Operations and Infrastructure
  • Performance Monitoring and Improvement
  • Consumer Protection and Empowerment

The certification process takes less than six months.

Who May Apply

  • Pre-Review Screening Certification – Organizations delegated pre-review screening functions or organizations providing support for this function.
  • Initial Clinical Review Certification – Organizations delegated initial clinical review functions or organizations providing support for this function.
  • Clinical Review Criteria Certification – Organizations providing clinical review criteria to other entities for their use in making utilization management review determinations.
  • Clinical Decision Support Certification – Organizations providing clinical decision support to other entities for their use in making utilization management review determinations.