What are three important functions of utilization management

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Reference no: EM133275647

1. In many healthcare organizations the following department is often responsible for developing policies and procedures aimed at accident and injury prevention.

Risk management

Health information management

Administration

Security

2. Which of the following is an occurrence, such as a medical error that may result in personal injury?

Root-cause analysis

Standard

Clinical protocol

Potentially compensable event

3. What are three important functions of utilization management?

Case management, discharge planning, and risk management

Discharge planning, risk management, and incident response

Incident response, risk management, and utilization review

Utilization review, case management, and discharge planning

4. Which of the following is the process of managing the legal and administrative aspects of the healthcare organization's response to injury claims?

Case management

Discharge planning

Claims management

Utilization management

5. Which of the following is an occurrence that resulted, or could have resulted, in life-threatening injuries to patients, medical staff, or employees?

Claims management

Sentinel event

Forcefield analysis

Benchmarking

6. What is the process that monitors and confirms that a patient receives consistent dosing across all facility transfers called?

Sentinel event

Risk management

Clinical documentation integrity

Medication reconciliation

7. The following document is used to help healthcare facilities identify and correct problem areas and prepare for legal defense. This document is for operational purposes, not used for patient care, and is never included in the health record.

Process indicator

Incident report

Score card

Financial report

8. Which of the following is an important part of quality patient care as it helps to ensure necessary and appropriate care, effectiveness of the services provided to the patient, and timely and safe discharge of patients?

Clinical performance measure

Performance improvement

Risk management

Utilization management

9. The basic functions of healthcare risk management programs are similar for most organizations and should include which of the following?

Reporting of claims, initial investigation of claims, protection of primary and secondary health records, negotiation of settlements, management of litigations, and use of information for claim's resolution in performance management activities

Risk acceptance, risk avoidance, risk reduction or minimization, and risk transfer

Safety management, security management, claims management, technology management, and facilities management

Risk identification and analysis, loss prevention and reduction, and claims management.

Reference no: EM133275647

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