utilization review
A systematic evaluation process to determine the medical necessity, appropriateness, and efficiency of mental health services and treatment plans.
Full Definition
Utilization review is a managed care function that evaluates whether mental health services are medically necessary, delivered at the appropriate level of care, and provided efficiently. In community psychiatry, this process typically involves clinical review of treatment plans, length of stay decisions for inpatient care, and authorization for intensive services. Utilization review can occur prospectively (before services), concurrently (during treatment), or retrospectively (after service delivery). The process aims to balance cost containment with quality care but can create administrative burden and potential barriers to needed services.
Usage
Usage note: Often abbreviated as 'UR' in clinical documentation.
In Context
- "The utilization review committee denied the request for extended residential treatment, citing insufficient documentation of medical necessity." — Clinical case notes
- "Concurrent utilization review requires daily assessment of patient progress and continued need for inpatient psychiatric care." — Hospital policy manual