Is Your Utilization Management Program Ready for What's Next?
Utilization management continues to evolve as organizations face increasing expectations around transparency, consistency, quality oversight and regulatory compliance.
NCQA’s updated Utilization Management Accreditation introduces a flexible, data-driven approach designed to align with how utilization management programs operate today.
Explore how NCQA can help strengthen your utilization management program.
Explore Benefits and SupportSpeak with a Program Expert
Why Utilization Management Programs Are Changing
Health plans, utilization review organizations and delegated entities are navigating a rapidly changing landscape.
Common challenges include:
- Adapting to evolving federal and state requirements
- Improving consistency in utilization review decisions
- Managing prior authorization workflows efficiently
- Demonstrating quality and program oversight
- Reducing administrative burden while maintaining compliance
Organizations are looking for practical frameworks that support both operational effectiveness and regulatory readiness.
What You'll Get From a Consultation
Connect with an NCQA Expert
Get guidance on your organization’s readiness and next steps.
Connect with an NCQA Expert
Learn the Accreditation Process
Understand timelines, requirements and steps to get started.
Learn the Accreditation Process
Access Standards and Guidelines
Explore Utilization Management Accreditation standards and requirements.
Access Standards and Guidelines
Evaluate Your Readiness
Use tools to assess your current utilization management program.
Evaluate Your Readiness
The updated Utilization Management program offers a modular approach tailored entirely to the operational functions you perform. Your accreditation can finally reflect your team’s actual responsibilities and capabilities.
Subscribe to our newsletter
Sign up below to receive Quality Matters, our bi-weekly newsletter, along with updates about our products and programs designed to support the improvement of health care quality.
