What is CVS Utilization Review?

CVS Utilization Review refers to the process used by CVS Health to evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. This process typically involves reviewing medical records, claims, and treatment plans to ensure that patients receive appropriate care while avoiding unnecessary services or costs. Utilization reviewers work to balance quality patient care with cost-effectiveness, often collaborating with healthcare providers to achieve the best outcomes. This role is important in managing healthcare resources and supporting insurance and pharmacy benefit management functions.