Which of the following best describes why utilization review departments are becoming case management units?
a. Funding is available for case management responsibilities.
b. Monitoring service use alone does not improve patient outcomes.
c. It facilitates using nurse experts for case management.
d. It promotes the current trend of naming "utilization review" units "case management."
ANS: B
Case management programs evolved from utilization review departments when those departments demonstrated that monitoring service use alone is insufficient for managing patient populations with diverse resource needs. There is not readily available funding for case management responsibilities. Case management involves more than utilization review, so there is a changing role of the nurse associated with the change of the name of the department. Using nurse experts for case management is beneficial, but it is not the reason why these departments transitioned.
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