Some Managed Care Plans Contract Out Utilization Management Services to a Utilization

question 38

Multiple Choice

Some managed care plans contract out utilization management services to a utilization review organization (URO) , which is an entity that __________.

• A) conducts a quality management program and completes focused review studies and medical audits
• B) establishes a utilization management program and performs external utilization review services
• C) performs risk management activities that result in appropriate in-service education for medical staff
• D) provides a service to the organization to ensure that physicians have met credentialing requirements

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Definitions:

Suprachiasmatic Nucleus

A small region in the brain located in the hypothalamus, responsible for controlling circadian rhythms.

Frontal Lobes

The part of the brain located just behind the forehead that is involved in complex cognitive functions, emotional regulation, and voluntary movement.

Pineal Gland

A small endocrine gland in the brain responsible for producing melatonin, a hormone that regulates sleep-wake cycles.

Environmental Changes

Modifications to the surroundings or habitat, often caused by human activities or natural phenomena, which can impact ecosystems and living conditions.