A lawsuit alleges that CVS Health did not properly pay utilization management and review nurses because it classified them as employees exempt from overtime pay, Class Action reported April 14. The ...

Jill O'Brien, Morton Hospital's new CMO, says the essence of utilization management is providing the right care for the right patient in the right setting at the right time. The new CMO of Morton ...

A nurse who worked for Highmark Inc. reviewing insurance coverage authorization requests filed a federal lawsuit against the company on Tuesday, alleging that it failed to pay required overtime. The ...

Health systems and health insurance plans spend enormous sums of money battling over how to be paid fairly — and these battles have only intensified with the growth of Medicare Advantage plans, which ...

Utilization management (UM) and prior authorization, which is the most commonly practiced form of utilization management, are both highly regulated, and health plans can face high penalties and fines ...