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Essay Available:
Pages:
2 pages/≈550 words
Sources:
3 Sources
Style:
APA
Subject:
Health, Medicine, Nursing
Type:
Coursework
Language:
English (U.S.)
Document:
MS Word
Date:
Total cost:
$ 11.66
Topic:

SLP Utilization Management, Utilization Review, and Case Management Essentials

Coursework Instructions:

Using the information in the background readings as well as some research in peer-reviewed sources of your own, create a professional-looking PowerPoint presentation of 10-14 slides (not including the title slide or the reference slide) which clearly summarizes each of the items below. Include thorough speaker’s notes to further expand upon and explain your points. Use in-text citations on your slides, as well as a reference slide at the end of the presentation.
Summarize the three types of assessment to be completed during utilization review. What is involved in each process and who completes this work? What is the health care manager’s specific role in the review?
Provide an example of how each of the three types of assessment are performed in the current health care settings. In your three examples, specifically explain how quality was/was not preserved, and how cost was/was not controlled.
Describe the role of communication between all stakeholders involved in utilization review. Who are each of the stakeholders, and how should this communication take place? How are decisions best made and communicated, when the review involves competing interests among stakeholders (e.g., for off-label drug uses for terminal patients, handling bed shortages, etc.).
SLP Assignment Expectations
Conduct additional research to gather sufficient information to support your presentation.
Provide 10-14 quality PowerPoint slides of bulleted-point information content (with speaker’s notes), not including title page and reference slides. Don’t forget to use in-text citations on the slides.
Support your paper with peer-reviewed articles and reliable sources. Use at least two references from peer-reviewed sources. 
and for evaluating internet sources:
Georgetown University Library. (n.d.). Evaluating internet resources.
You may use the following source to assist in your formatting your assignment:
Purdue Online Writing Lab. (n.d.). General APA guidelines. 
Paraphrase all source information into your own words carefully, and use in-text citations.
Be sure that you do not cut and paste material into your slides, but use proper quotations where needed, and also citations for all reference materials. The same expectations apply to PowerPoint presentations as to documents.
Here is the background reading: Please note that i am aware that assignment should be done on PPT slide- please provide answers in a 2 page word doc- i will prepare the slides myself. Thank you so much!
Required Reading/Viewing
View:
Baker, J. (2018). Improving quality of care through utilization management [Video]. YouTube.
Carasso, S. (2017). Is that test necessary? The key to laboratory utilization management.
The Journal of Medical Practice Management: MPM, 33(3), 160-164. 
Desai, S., Gruber, P. F., Eiting, E., Seabury, S. A., Mack, W. J., Voyageur, C., . . . Terp, S. (2017). The effect of utilization review on emergency department operations. Annals of Emergency Medicine, 70(5), 623-631.e1. 
El-Othmani, M. M., Sayeed, Z., Ramsey, J. A., Abaab, L., Little, B. E., & Saleh, K. J. (2019). The joint utilization management program: Implementation of a bundle payment model and comparison between year 1 and 2 results. The Journal of Arthroplasty, 34(11), 2532-2537.
Parast, M. M., & Golmohammadi, D. (2019). Quality management in healthcare organizations: Empirical evidence from the Baldrige data. International Journal of Production Economics, 216, 133-144. 
Šuklar, S. (2019). Ensuring and measuring quality in primary healthcare. Revija Za Univerzalno Odličnost, 8(2), 153-168.
Wakefield, E., Keller, H., Mianzo, H., Nagaraj, C. B., Tawde, S., & Ulm, E. (2018). Reduction of health care costs and improved appropriateness of incoming test orders: The impact of genetic counselor review in an academic genetic testing laboratory. Journal of Genetic Counseling, 27(5), 1067-1073. 
Optional Reading
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. 

Coursework Sample Content Preview:


MHA 540 Module 2 – SLP Utilization Management, Utilization Review, and Case Management Essentials
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Utilization evaluation is essential to healthcare resource management. To achieve this, prospective, concurrent, and retrospective assessments are essential. Each examination involves different healthcare specialists and techniques. The healthcare manager is crucial to these assessments' success. This paper will explain each evaluation type, its methods and functions, and use examples from modern healthcare to demonstrate quality and cost management. It will also examine how stakeholders must communicate to overcome clashing interests in usage review.
Prospective Evaluation
Prospective assessment pre-authorizes medically necessary and appropriate healthcare services. A nurse or doctor requests a procedure, treatment, or service from the utilization review department. The review department nurses or medical coders assess the request for clinical guidelines, medical necessity, and appropriateness. If these criteria are met, the request is accepted. Otherwise, it may be refused or reviewed by a physician advisor. In modern healthcare, consider a patient who needs an expensive surgery. Through prospective assessment, the healthcare manager may guarantee the patient obtains the essential procedure while limiting expenses (Desai et al., 2017). Quality was retained, and cost was controlled by careful request appraisal if the procedure was medically necessary.
Concurrent Assessment
Concurrent assessment entails monitoring a 

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