Utilization Management Program Assessment Questionnaire
Assess your utilization management program across workflow, review standards, capacity, and improvement priorities.
Program Overview
Organization / Department Name
*
Role / Title
*
Program Type / Service Line Being Assessed
*
Inpatient Utilization Management
Outpatient Utilization Management
Emergency Department Review
Case Management
Care Coordination
Prior Authorization
Concurrent Review
Discharge Planning
Other
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Operational Capacity and Workflow
Current review volume per week
*
Current review volume per month
*
Primary review channels used
*
Phone
Fax
Portal
Email
EHR/Work Queue
Other
Staffing adequacy
*
More than adequate
Adequate
Somewhat inadequate
Significantly inadequate
Major workflow bottleneck
Improvement Priorities
Top three improvement priorities
*
Process efficiency
Staff training and development
Technology and automation
Policy and procedure updates
Member/Patient communication
Reporting and analytics
Compliance and audit readiness
Other
Desired implementation timeline
*
0-3 months
3-6 months
6-12 months
12+ months
Additional comments or recommendations
Submit Assessment
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