National Case Management Week is a vital opportunity to recognize the critical role case managers play in helping patients navigate complex care. By ensuring that utilization management supports timely, appropriate, and evidence-based treatment, these professionals directly influence patient success. Case managers frequently sit at the complex intersection of patients, providers, and health plans. They act as essential advocates throughout the healthcare lifecycle, actively resolving systemic barriers related to prior authorizations, insurance denials, and appeals.
As utilization management continues to evolve alongside the growing use of artificial intelligence, the need for human oversight remains paramount. Effective collaboration between case management and new technological tools can reduce administrative burdens and improve transparency, but technology cannot replace human advocacy.
Industry leader Michael B. Garrett, MS, CCM, CVE, CPCHE, explores these shifting dynamics and strategies for optimization in the recent CMSA Today feature, Optimizing Utilization Management in Professional Case Management Practice.
- Read the full article here(opens in new tab)
- Learn more about URAC’s Health Utilization Management accreditation(opens in new tab)
- Learn more about URAC’s Case Management accreditation(opens in new tab)
