Overview

Utilization Management, Care Management, Independent Review and other patient management activities are a vital part of today’s health care landscape. It’s essential that these organizations exhibit the highest quality.

URAC sets the bar for quality in patient management with the development of the first-ever voluntary accreditation programs in this sector. Your partners recognize URAC as the leading independent accrediting body in the United States for patient management activities.

Only URAC brings you the wide range of expertise and industry insight that comes from accrediting more health care organizations in more sectors. URAC brings together innovators—including payers, providers and vendors—from throughout the health care ecosystem to help develop quality improvement programs that protect your organization and prepare it to thrive.

Health care organizations across the United States select URAC as an accreditation partner by design:

  • Industry knowledge. URAC offers clients a remarkable width and depth of industry expertise, best practices and data gleaned over 30 years and the development of 40+ programs. That body of knowledge grows daily.
  • Collaboration. Every health care organization is different. The URAC team of experts works closely with each client to customize a supportive process that is not prescriptive yet guides them toward achieving their specific goals.
  • Prestige. URAC, one of the oldest and most trusted independent quality validators, is highly regarded for its thorough, science-based standards.

Health Utilization Management Accreditation

Applies to stand-alone UM Organizations and to UM functions inside health benefit programs

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Health Utilization Management Certification

Performs pre-review/initial screening by non-clinical staff

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Independent Medical Examination Accreditation

Performs and/or delegates an independent, objective assessment of a patient's medical condition

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Independent Review Organization Accreditation

Provides third-party medical review resouce for objective, unbiased review decisions

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Case Management Accreditation

Provides for interactive care coordination in collaboration with patients and other stakeholders

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Health Call Center Accreditation

Provides for clinical services and support via phone for patients

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Disease Management Accreditation

Manages a population with chronic disease and co-morbidities

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Workers’ Compensation Utilization Management Accreditation

Provides for determination of medical necessity for workers covered under a Workers' Compensation program

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Opioid Stewardship Designation

Manages patients' use of or access to opioid medication.

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Transitions Of Care Designation

Coordinates services, education and information-sharing between hospitals, physicians, post-acute care providers and patients

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Specialty Physician Practice Dispensing Accreditation

Physician's office dispensing specialty medications from a physician order.

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Why URAC

URAC’s Patient Management accreditation offer unmatched prestige for organizations that achieve the URAC accreditation seal – recognized by health plans, employers, regulators and providers, as the gold standard in accreditation.

URAC’s accreditation standards provide key performance benchmarks, raise the bar on quality improvement efforts, and support consumer protection and empowerment. URAC’s facilitative approach to the accreditation process encourages learning in the organization, leading to improved operations and regulatory compliance activities.