Q&A: Physician engagement in the UR process

February 7, 2018
Medicare Web

Q. What strategies can case managers employ to engage physicians in the utilization review (UR) process?

A. Essential steps to effectively engage physicians in the UR process:

  1. Explain the why.
  2. Influence through the art of negotiation. Accept that anger is often the first step in negotiation on the way to reaching an agreement. Avoid an emotional response. Know when to disengage.
  3. Effective communication. Be present and fully engaged in the conversation through active listening and making eye contact. Be curious rather than judgmental. Respect what the other person has to say. Be authentic and humble, but say what you mean. Ensure reasoning is as transparent as possible.
  4. Conflict resolution. “The key to successful conflict resolution lies in understanding the motivations and challenges of the other party” (Patterson, Grenny, McMillan, and Switzler, 2002).

For more information, see Case Management Models: Best Practices for Health Systems and ACOs, Second Edition.

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