Health Utilization Management Certifications

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Meet the needs of your URAC-accredited partners with URAC’s Health Utilization Management Certifications

If your organization provides delegated or other support services to URAC-accredited Health Utilization Management (HUM) organizations, HUM Certifications can help offer you a competitive advantage. URAC’s HUM Certification can position your organization to better compete for contracts and demonstrates to your business partners that you have a proven commitment to high performance. The certifications also indicate that you have embedded quality management principles into your daily operations.

Additionally, these certifications mean 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 choosing a service provider or delegated entity.

The certification process encourages you to review and confirm your operational soundness, set priorities, drive organizational improvements, and build strong processes. When an organization achieves URAC’s Health Utilization Management Certification, it publicly demonstrates your commitment to quality and competitively positions you to build your business.

There are four HUM certifications, which means you can choose the one(s) that are right for your business operations – you can start with one and then add others once your company’s business expands. Once you request a quote our team can help you decide which certifications are right for you.

  • Pre-Review Screening Certification – also known as “initial screening” where staff is set up with the right information and support to provide excellent customer service
  • Initial Clinical Review Certification – qualified professionals render certifications or move the review to the next level in a timely, responsive manner
  • Clinical Review Criteria Certification - used in the evaluation of medical necessity, criteria are regularly and rigorously reviewed by clinicians with the right credentials and experience
  • Clinical Decision Support Certification – promotes an effective and efficient utilization management process optimizing workflow and outcomes

In addition to certification-specific standards, all HUM Certifications include the following Foundational Focus Areas:

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

You can see our Standards-at-a-Glance here for more details

If you are a delegating HUM organization, our HUM Accreditation is right for you.

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