The American Journal of Managed Care

Utilization Management in Women’s Health

A medical professional explains the many facets of the prior authorizations process for drugs in women’s health. Ryan Haumschild, PharmD, MBA, MS: Prior authorizations are something that we’re used to ...

Abarca Forward 2026 Marks Five Years of Industry Momentum with a Bold Agenda to Reimagine Prior Authorization and Utilization Management

Abarca Health hosted the fifth edition of Abarca Forward 2026, bringing together senior healthcare leaders from across the ...

National Survey Shows Insurer Utilization Management Interferes with Cancer Treatment Decisions

COA survey of independent community oncology practices shows insurer requirements delay treatment, override clinical ...
Fierce Healthcare

Study: Utilization management has ramped up in Part D over past decade

Utilization management in Medicare Part D has become more restrictive over the last decade, even when compared to Medicare Advantage prescription drug plans, according to a new study. The study, ...
HealthLeaders Media

The Exec: How to Succeed in Utilization Management

Jill O'Brien, Morton Hospital's new CMO, says the essence of utilization management is providing the right care for the right patient in the right setting at the right time. The new CMO of Morton ...
Becker's Hospital Review

8 Managed Care Contract Questions Regarding Utilization and Management

8 Managed Care Contract Questions Regarding Utilization and Management Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask ...
Becker's Hospital Review

“Utilization Management” is all about saving health plans money. or is it?

In a recent blog post, Medecision discusses utilization management and its shifting definition. The term “Utilization Management” was first heard in healthcare roughly three decades ago. The Institute ...
The American Journal of Managed Care

Impact of Utilization Management on Physician Autonomy and Shared Decision-Making in Oncology

Panelists discuss how utilization management limits clinical autonomy and advocate for reforms that preserve shared, patient-centered decision-making. Panelists discuss how increasing utilization ...
Health Affairs

Drug Coverage Policies And Clinical Guidelines Alignment: Most Coverage Decisions Include Additional Restrictions

Although the literature has investigated utilization management practices, how they align with clinical practice guidelines is not well understood. 10, 11 A better understanding of this alignment ...
Business Wire

Dane Street Achieves NCQA Accreditation in Utilization Management

PALM BEACH GARDENS, Fla.--(BUSINESS WIRE)--Dane Street, a national leader in Independent Medical Exams and Reviews, announced today that it has achieved Accreditation in Utilization Management from ...
Health Affairs

The Role Of Utilization Management: The Authors Reply

We appreciate the thoughtful response of Susan Cantrell and the Academy of Managed Care Pharmacy to our work (August 2021). Our study highlights the burden of drug utilization management on the ...
HealthLeaders Media

The Exec: New CMO Shares Insights on Effective Utilization Management

For clinical leaders, accurate data and strong relationships with staff members are foundational for utilization management, this new CMO says. The new CMO of AdventHealth New Smyrna Beach says having ...