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

Utilization management primarily relies on evidence-based criteria to make informed decisions about the appropriateness and necessity of healthcare services. This approach utilizes clinical guidelines, research findings, and best practices that have been proven effective through rigorous scientific studies. By adhering to these criteria, healthcare professionals can ensure that patients receive the most beneficial interventions while minimizing unnecessary treatments, which can lead to better health outcomes and more efficient use of resources.

In contrast, subjective clinical opinions and personal experiences of providers vary widely from one practitioner to another and do not offer the same level of objectivity and reliability as evidence-based criteria. Patient feedback surveys can provide valuable insights into patient satisfaction and experiences, but they are not typically used as criteria for determining the necessity of medical services in utilization management. Overall, the emphasis on evidence-based criteria helps standardize care and improve the quality of health services delivered.