Which statement accurately differentiates utilization management from case management?

• A. Utilization management focuses on appropriate use of services and costs.
• B. Case management primarily emphasizes improving social determinants of health, not care planning.
• C. Utilization management handles scheduling and administrative tasks.
• D. Case management is unrelated to patient care coordination.

Answer: (A)

Utilization management is about the appropriate use of health services and their costs. It evaluates whether a service is medically necessary, appropriate for the setting and level of care, and aligned with evidence-based guidance, with the goal of using resources wisely. That focus on necessity and efficiency is what makes the statement about utilization management and costs the best choice.

Case management, by contrast, centers on coordinating a patient’s care across multiple providers and settings, designing and monitoring a care plan, and addressing barriers to access — including social determinants of health. It’s not primarily about scheduling or administrative tasks, and it certainly isn’t separate from care coordination.