Utilization Review and Management
Manual
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Center 		|
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Funded
Clients 		|
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Plan
Members 		|
|		 Utilization
Review 		|
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of
Care 		|
|		 Glossary |
|		 Forms

Utilization
Review

Quick
Reference
Guide

EOB -- United
Medical
Resources
Sample
Explanation of
Benefits

Outpatient
Services

Intensive
Services

Clinical
Denials

Appeals
Process 		Utilization Review and Management monitors and evaluates the clinical necessity, appropriateness and efficiency of behavioral health-care services, procedures or level of care. It coordinates services to promote health and wellness, and to maximize independence and resources to support clients and members in their recovery.

Concurrent Review
Concurrent reviews occur when clients and members are initially assessed as no longer meeting the continued stay criteria for the service or level of care they are receiving. Concurrent reviews occur while the service or level of care is being delivered.