Critics of utilization review frequently are concerned that many of those persons participating in a utilization review are in fact practicing medicine. Although UR is conducted prospectively, it is used to authorize or refuse proposed treatments, referrals, and even hospital admissions.
- Does UR constitute “practicing medicine” and if so should UR be limited to only those medical professionals licensed to practice medicine?
- Discuss who you think should head the utilization review program and justify your answer.
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