HUMANA MEDICAL QUALITY COST MANAGEMENT

REVIEWING AND EVALUATING HEALTH CARE SERVICES; NAMELY, HOSPITAL PRE-ADMISSION AND PRE-SURGICAL SCREENING FOR ALL NON-EMERGENCY ADMISSIONS; CONTINUED STAY REVIEW OF INPATIENT CARE TO DETERMINE THE APPROPRIATENESS AND NECESSITY OF SUCH CARE; DISCHARGE PLANNING; AND RETROSPECTIVE REVIEW OF INPATIENT AND OUTPATIENT CARE TO DETERMINE THE APPROPRIATENESS AND NECESSITY OF SUCH CARE