could totally be paranoia but our UM caseloads are down significantly. Asked my coworkers if I was being illogical to think they could be siphoning them to run through automated systems to see how it would go without us. In theory our system should already be able to do it.
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UM = Utilization Management
I have been a UR/UM nurse for years (not all at this company), and cases always come in highs and lows. I honestly don't see how they could automate cases and, even if they were able to, they would have to be audited. And I'm guessing there are some URAC issues with automation. Just my thoughts.
They’ve been this low before. They might be able to automate some parts of UM, but I’m not sure how they get around the clinicians that need to sign off on those cases to resolve them. They need their license so it doesn’t make sense to me to cut UM unless they revamp their benefits to just do automatic denials over visit thresholds. Idk though just my 2 cents
I’m assuming they mean Utilization Management.
You might want to define what "UM" means.