Commission for Case Manager Certification (CCMC) Practice Exam 2025 - Free Case Manager Certification Practice Questions and Study Guide

Utilization management in the context of Integrated Case Management (CM) refers to the process of managing resource use to ensure that patients receive appropriate care. It involves evaluating the necessity, appropriateness, and efficiency of healthcare services, which includes assessing treatment plans and monitoring the use of clinical resources. This system is designed to prevent overutilization or underutilization of services, thereby optimizing patient care while also considering the cost-effectiveness of the services provided.

This approach emphasizes maintaining the quality of care while ensuring that resources are used judiciously, aligning with healthcare goals of improved patient outcomes and sustainability. Therefore, the focus on managing resource use and ensuring appropriate care is pivotal in effective utilization management.

The other options, while related to certain aspects of healthcare management, do not encapsulate the full scope of utilization management as a systematic approach to evaluating the appropriateness of care and resource use. Tracking emergency room visits, coordinating patient referrals, and conducting surveys can play supportive roles in broader case management efforts but do not specifically define the utilization management process.