In a breakout session at XCHANGE 2019, Rena Arden, corporate supervisor of utilization management at Knoxville, Tennessee-based Covenant Health, shared the lessons learned when the health system centralized its utilization management process. Because each of Covenant Health’s seven original facilities had their own case management (CM) and utilization management (UM) department, the process involved a lot of moving parts. At larger facilities, commercial UM operated separately from the combined Medicare UM/CM model, and at smaller facilities, the distribution of reviews depended on the availability of staff. Healthcare regulations change all the time and keeping up would be difficult if UM remained in separate hospitals, Arden explained. Needless to say, centralizing the process was critical.


Source: Centralizing the Utilization Review Process